# LIBRARY OF CONGRESS, 

: ( 

! UNITED STATES OF AMERICA.* 



PRACTICAL ANATOMY. 

A NEW ARRANGEMENT 

OF THE 

LONDON DISSECTOR. 

I 

WITH 

NUMEROUS MODIFICATIONS AND ADDITIONS, 

CONTAINING 



A CONCISE DESCRIPTION OF THE MUSCLES, BLOODVESSELS, 

NERVES, VISCERA, AND LIGAMENTS OF THE HUMAN 

BODY AS THEY APPEAR ON DISSECTION. 



With $£lln8t%xH*ug. 



BY 



D. HAYES AGNEW, M.D., 

|V 
Demonstrator of Anatomy and Assistant Lecturer on Clinical Surgery in the University of 
Pennsylvania, Surgeon to the Pennsylvania Hospital and the Will's Ophthalmic 
Hospital, etc. etc. 



SECOND EDITION, REVISED. . _ 

18 

PHILADELPHIA: C/« ~. 

^ofvy. 
J. B. LIPPINCOTT & CO. 



1868. 



A 



K ^ ^ 






Entered, according to Act of Congress, in the year 1867, by 

J. B. LIPPINCOTT & CO., 

In the Clerk's Office of the District Court of the United States for 
the Eastern District of Pennsylvania. 






PREFACE 



THE AMERICAN EDITOR. 



The Editor of the following pages, believing that a dis- 
sector suited to the wants of the American Student should 
be much more condensed than those in general use, has 
made the following arrangement of the London Dissector. 
In its preparation the arrangement has been entirely altered, 
and the nomenclature in many cases changed. The Liga- 
mentous system : illustrations and numerous other additions 
in various parts of the work have been made; everything 
considered unnecessary erased ; and the whole presented as 
near as possible in topographical order. The minute anat- 
omy of parts, and the smaller ramifications of the nervous 
and vascular systems have been omitted, belonging as they 
do more properly to systematic treatises on Special Anatomy. 

The work has been prepared with an eye single to the 
faithful economy of the Student's time. 

D. HAYES AGJSTEW. 

August, 1856. 

cm) 



PREFACE 

TO THE 

SECOND EDITION 

BY THE AMERICAN EDITOR. 



The first edition of this book on Practical Anatomy 
having been exhausted, and the favorable manner in which 
it has been received, have induced the preparation of a 
second edition. 

The same care in this as in the former one has been ob- 
served, to compress the matter into as small a compass as 
would consist with perspicuity. 

D. HAYES AGNEW, 

1611 Chestnut Street. 

August 22, 1867. 



(v) 



CONTENTS. 



CHAPTER I. 

PAGE 

General Observations in Reference to Dissecting 9 

CHAPTER II. 
Dissection of the Head 10 

CHAPTER III. 
Dissection of the Face 14 

CHAPTER IV. 

Of the Contents of the Cranium, or the Brain arid its Mem- 
branes 32 

CHAPTER V. 
Dissection of the Anterior Part of the Neck 55 

CHAPTER VI. 
Dissection of the Throat 78 

CHAPTER VII. 
Dissection of the Orbit of the Eye 87 

CHAPTER VIII. 
Dissection of the Thorax 93 

CHAPTER IX. 
Dissection of the Superior Extremity 100 

(vii) 



Vlll CONTENTS. 



CHAPTER X. 

PAGE 

Dissection of the Abdomen 140 

CHAPTER XL 
Dissection of the Anterior Part of the Thigh 174 

CHAPTER XII. 

Dissection of the Perineum and of the Male Organs of Genera- 
tion 220 

CHAPTER XIII. 
Dissection of the Organs of Generation in the Female 236 

CHAPTER XIV. 
Of Parts within the Thorax 244 

CHAPTER XV. 

Dissection of the Muscles on the Posterior Part of the Trunk 

and Neck 261 

CHAPTER XVI. 
Dissection of the Muscles situated between the Ribs, and on the 

Inner Surface of the Sternum 275 

CHAPTER XVII. 
Dissection of the Eye 277 

CHAPTER XVIII. 
Ligaments 281 



PRACTICAL ANATOMY. 



CHAPTER I. 

GENERAL OBSERVATIONS IN REFERENCE TO 
DISSECTING. 

The student about commencing the duties of the dis- 
secting room, should be supplied with a good apron to 
protect his clothes from being soiled and a dissecting 
case of good quality. The knife should be held like a 
pen, and moved by the fingers and thumb, not by the 
wrist and elbow, and sometimes, as I have seen, by the 
shoulder. The student should practice its use also with 
the left hand; such an education will be of great advant- 
age, especially in surgical operations. In the dissection 
of a part, it is a good rule not to turn off more of the 
skin than is necessary for the exposure of the part, and 
always to replace it again during the interval of dissec- 
tion. Generally I think it better to turn off the struc- 
tures in the order of superposition ; as the skin, super- 
ficial fascia, deep fascia, etc. In dissecting a muscle the 
parts should be made tense, which is done by blocks 
properly placed under the subject. The cellular mem- 
brane which immediately invests the muscle, must be 
kept extended by the hand or forceps, -and the edge of 
the knife carried steadily in the direction of its fibres. 
This rule admits of no exceptions, and should never be 
lost sight of by the student. 

There are many operations which may be done on the 
subject without injuring the parts for dissection; such 
as the ligation of arteries; passage of instruments 

2 (9) 



10 PRACTICAL ANATOMY. 

through the nasal fossae and their introduction into the 
^Eustachian tube; introduction of catheter, both in the 
male and female, etc.; and these should be practiced 
with care. The grand object of the student in the ex- 
amination of the human body, should be not only to re- 
cognize its constituents, but above all the relation which 
they sustain to each other; this is the only knowledge 
worth obtaining, and the want of it accounts for the 
blunders, confusion, and ignorance which are so fre- 
quently seen in the profession. Another point of much 
importance is order and cleanliness. Hence all drip- 
pings from the subject should be wiped up with the 
sponge, and no scraps allowed to accumulate about the 
table. Much apprehension is sometimes expressed by 
students about poisoned wounds. It is well if there be 
any abrasions of the skin to cover it with collodion be- 
fore engaging in dissecting ; but since the introduction of 
the chloride of zinc as an antiseptic all danger from this 
source is removed. Where an accidental cut is inflicted, 
the part should be washed, and well drawn by the mouth. 
The common practice of cauterizing with the nitras 
argenti, I think is in many cases positively injurious, 
unless well drawn first. 



CHAPTER II. 

DISSECTION OF THE HEAD. 

Of the External Parts of the Head. 

The integuments of the head are thick, and covered 
with hair ; under the cutis there is a cellular substance, 
which is much condensed, and closely connected with 
the epicranium, or expanded tendon of the occipito- 
frontalis. This connection renders the dissection of 
that muscle difficult. 



EXTERNAL PARTS OF THE HEAD. 11 

An incision should be made from the root of the nose 
over the median line of the head, terminating behind at 
the occipital protuberance; a second from the com- 
mencement of the first, over the eyebrows to the exter- 
nal angular process of the frontal bone; a third from 
the occipital protuberance to the mastoid process of the 
temporal bone ; by dissecting very carefully the flap 
outward, the entire muscle and intervening tendon or 
aponeurosis will be exposed. 

The Occipito-frontalis is the only muscle which 
properly belongs to the hairy scalp ; it is a single broad 
digastric muscle. 

Arising, on each side of the head, fleshy and tendin- 
ous, from the transverse ridge of the occipital bone, as 
far forward as the mastoid process ; it forms a broad, 
thin tendon, which covers the whole upper part of the 
cranium. 

Inserted, fleshy, on each side, into the orbicularis 
palpebrarum, skin of the eyebrows, and the internal 
angular process of the os frontis and os nasi. The last 
insertion answers to the Pyramidalis Nasi of some books. 

Situation. The tendon adheres firmly by cellular 
membrane to the skin, but very loosely to the pericra- 
nium or periosteum of the cranium, by a loose cellular 
layer, which might be called the subaponeurotic fascia. 
At its insertion it intermixes with the muscles of the 
upper part of the face. 

Use. To pull the skin of the head backward, raise 
the eyebrows, and corrugate the skin of the forehead. 

Bloodvessels seen in the dissection of the scalp are 
the Frontal, emerging from the internal angle of the 
orbit and passing up the middle of the head. Supra- 
orbital out of the Supra-orbital foramen; both branches 
of the Ophthalmic. On the side of the head the Tem- 
poral, from the external carotid, behind the Posterior 
Occipital, and Posterior Auricular from the ex- 
ternal carotid. All anastomose in the scalp. 

The Supra-orbital Nerves coming out of the supra- 
orbital foramen. The Frontal Nerve, a branch of 
the ophthalmic, which last is the first branch of the fifth 



12 PRACTICAL ANATOMY. 

pair; on the side, branches of the Portio Dura and 
Inferior Maxillary Nerves ; and behind, the Occi- 
pitalis Minor and Major — the former from the super- 
ficial plexus of the neck, and the latter the main stalk 
of the second cervical spinal nerve. 

The muscles of the ear are of three classes. 

1. The common muscles move the external ear; they 
are not always so distinct as to admit of a clear demon- 
stration. 

(1) Attollens Aurem — Arises from the tendon of 
the occipito-frontalis, and from the aponeurosis of the 
temporal muscle. 

Inserted into the upper part of the root of the car- 
tilage of the ear, opposite to the antihelix. 
Use. To draw the ear upward. 

(2) Anterior Auris — Arises, thin and membranous, 
from the posterior part of the zygomatic process of the 
temporal bone. 

Inserted into a small eminence on the back of the 
helix, opposite to the concha. 

Use. To draw the eminence a little forward and up- 
ward. 

(3) The Retrahentes Auris — Arise, by two or 
three distinct slips, from the external and posterior part 
of the mastoid process, immediately above the insertion 
of the sterno-cleido mastoideus. 

Inserted into that back part of the ear which is op- 
posite to the septum, dividing the scapha and concha. 

Use. To draw the ear back and stretch the concha. 

Before describing the proper muscles of the ear, no- 
tice the following. The part usually called ear is for 
the most part cartilaginous; appended to it below is a 
pendulous portion, the Lobus, composed of granulated 
fat and dense cellular membrane ; with the exception of 
this, all above is the Pinna. The deep cavity in the 
middle is the Concha. Dividing the upper part of the 
concha into two unequal fossae is a ridge which runs 
along the circumference of the pinna and ends in the 
lobus; this is the Helix — within it another, the Anti- 
helix. On the anterior part of the concha is a projec- 



EXTERNAL PARTS OP THE HEAD. 13 

tion, the Tragus, and opposite another, the Antitra- 
gus. Under the rim of the helix is the Fossa Innomi- 
nata, and in the bifurcation of the helix is the Scapha. 
The external Auditory Meatus is about one inch in 
depth, its direction moderately forward and inward; 
under the skin which lines the meatus are the Ceru- 
minous Glands. 

2. The proper muscles of the ear must be here de- 
scribed; but the student must not expect to meet with 
them distinctly marked in every subject: in general, 
they are very confused and indistinct. 

(1) Helicis Major — Arises from the upper and 
acute part of the helix, anteriorly. 

Inserted into its cartilage, a little above the tragus. 
Use. To depress the part from which it arises. 

(2) Helicis Minor — Arises from the inferior and 
anterior part of the helix. 

Inserted into the crus of the helix, near the fissure on 
the cartilage opposite to the concha. 
Use. To contract the fissure. 

(3) Tragicus — Arises from the middle and outer 
part of the concha, at the root of the tragus, along 
which it runs. 

Inserted into the point of the tragus. 

Use. To pull the point of the tragus a little forward. 

(4) Antitragicus — Arises from the internal part of 
the cartilage that supports the antitragus ; and, running 
upward, is 

Inserted into the tip of the antitragus as far as the 
inferior part of the antihelix. 

Use. To turn the tip of the antitragus a little out- 
ward, and depress the extremity of the antihelix to- 
ward it. 

(5) Transversus Auris — Arises from the prominent 
part of the concha on the dorsum of the ear. 

Inserted opposite to the outer side of the antihelix. 
Use. It draws the parts to which it is connected to- 
ward each other, and stretches the scapha and concha. 



14 PRACTICAL ANATOMY. 



CHAPTER III. 

DISSECTION OF THE FACE. 

Of the Muscles. 

To expose these muscles an incision should be carried 
from the root of the nose to its tip, around the margin 
of the nostril to the centre of the upper lip, down to its 
margin, around its border to an opposite point on the 
lower lip, and then to the symphysis of the chin. From 
the termination of the last a second may be carried 
along the base of the jaw to the mastoid process of the 
temporal bone. Reflect the integuments outward. 

Under the integuments of the face, there is always a 
considerable quantity of adipose membrane; many of 
the muscles are very slender, and lying imbedded in this 
fat, require careful dissection. The whole side of the 
face is also supplied with numerous ramifications of the 
facial nerve, or portio dura of the seventh pair. These 
nervous twigs are generally removed with the integu- 
ments. If it is desired to save them, the skin only 
should be removed first. 

Twelve pairs of muscles, and one single muscle, are 
described in this dissection. 

1. The Orbicularis Palpebrarum — Arises from 
the internal angular process of the frontal bone, and 
from a tendon at the inner angle of the eye, by a num- 
ber of fleshy fibres which pass round the orbit, covering 
first the superior and then the inferior eyelid, and also 
the bony edges of the orbit. 

Inserted, by a short round tendon, the Tendo Oculi, 
into the nasal process of the superior maxillary bone. 
The above tendon lies across the lachrymal sac. 

Situation. This muscle is intermixed, at its upper 
part, with the occipito-frontalis. 



MUSCLES OF THE FACE. 15 

Use. To shut the eye, by bringing down the upper 
lid, and pulling up the lower; the fibres contracting to- 
ward the inner angle, as to a fixed point, compress the 
eyeball and lachrymal gland, and convey the tears to- 
ward the puncta lachrymalia. 

The ciliaris is only a part of the muscle covering the 
cartilages of the eyelids, which are called the Cilia or 
Tarsi; Maxillo- palpebral. 

2. The Corrugator Supercilii — Arises, fleshy, 
from the internal angular process of the os frontis ; it 
runs outward and a little upward, to be 

Inserted into the inferior fleshy part of the occipito- 
frontalis muscle, extending outward as far as the middle 
of the superciliary ridge. 

Situation. This muscle is concealed by the occipito- 
frontalis. It lies close to the upper and inner part of 
the orbicularis palpebrarum, with which it is connected. 

Use. To smooth the skin of the forehead, by pulling 
it down after the action of the occipito-frontalis. When 
it acts more forcibly, it pulls down the eyebrow and 
skin of the forehead, and produces vertical wrinkles. 

3. The Compressor Naris — Arises, narrow, from 
the outer part of the ala nasi, and neighboring part of 
the os maxillare superius. From this origin a number 
of thin separate fibres run up obliquely along the carti- 
lage of the nose toward the dorsum nasi, where the mus- 
cle joins its fellow, and is 

Inserted, slightly, into the lower part of the os nasi 
and nasal process of the superior maxillary bone. 

Situation. It is superficial; its origin is connected 
with the levator labii superioris absque nasi. 

Use. To compress the ala toward the septum nasi; 
but, if the fibres of the occipito-frontalis, which adhere 
to it, act, the upper part of this muscle assists in pulling 
the ala outward. It also corrugates the skin of the 
nose. 

4. Levator Labii Superioris Al^ique Nasi — Arises 
by two distinct origins : the first from the nasal process 
of the superior maxillary bone, where it joins the os 
frontis at the inner canthus of the eye; it descends along 



16 PRACTICAL ANATOMY. 

the nasal process, and is inserted into the outer part of 
the ala nasi, and into the upper lip. The second arises, 
broad and fleshy, from the margin of the orbit ar pro- 
cess of the superior maxillary bone, immediately above 
the foramen infra-orbitarium ; it runs down, becoming 
narrower, and is inserted into the upper lip and orbicu- 
laris oris. 

Situation. The first portion is sometimes called Le- 
vator Labii Superioris Alseque Nasi, and the second 
Levator Labii Superioris Proprius. Their origins are 
partly covered by the orbicularis palpebrarum. They 
descend more outwardly than the ala nasi. 

Use. To raise the upper lip toward the orbit, and a 
little outward; the first portion will also draw the ala 
nasi upward and outward. 

Bloodvessels and Nerves. — Below the orbital ori- 
gin of this muscle will be seen the Infra-orbital 
Bloodvessels and Nerves coming out of the infra- 
orbital foramen. The artery is from the internal max- 
illary, the nerve from the superior maxillary branch of 
the fifth pair; a nerve of common sensation. 

5. Zygomaticus Minor — Arises from the upper 
prominent part of the os malse, and, descending ob- 
liquely downward and forward, is 

Inserted into the upper lip near the corner of the 
mouth. 

Situation. Its origin is covered by the orbicularis pal- 
pebrarum. 

Use. To draw the corner of the mouth and upper lip 
obliquely upward and outward. 

6. Zygomaticus Major — Arises, fleshy, from the os 
mate, near the zygomatic suture. 

Inserted into the angle of the mouth, appearing to be 
lost in the depressor anguli oris, and orbicularis oris. 

Situation. Its origin is partially covered by the orbicu- 
laris palpebrarum; it lies more outwardly than the 
zygomaticus minor. 

Use. To draw the corner of the mouth and under 
lip upward and outward. 

7. The Levator Anguli Oris — Arises, thin and 



MUSCLES OF THE FACE. 17 

fleshy, from a depression of the superior maxillary bone 
betwixt the root of the socket of the first dens molaris, 
and the foramen infra-orbitarium. 

Inserted, narrow, into the angle of the mouth. 

Situation. It lies more outwardly than the levator 
labii superioris alaeque nasi ; it is in part concealed by 
that muscle, by the zygomaticus minor, and part of the 
zygomaticus major. At its insertion it is connected with 
the depressor anguli oris. 

Use. To draw the corner of the mouth upward. 

8. The Depressor Anguli Oris — Arises, broad and 
fleshy, from the lower edge of the inferior maxillary 
bone, at the side of the chin, and gradually becoming 
narrower, is 

Inserted into the angle of the mouth. 

Situation. This muscle is firmly connected with the 
platysma myoides; at its insertion it is blended with the 
zygomaticus major and levator anguli oris. 

Use. To pull down the corner of the mouth. 

9. The Depressor Labii Inferioris — Arises, fleshy 
and broad, from the side of the lower jaw, a little above 
its lower edge; it runs obliquely upward and inward, 
and is 

Inserted into the edge of the under lip. 

Situation. This muscle, at its insertion, decussates 
with its fellow. It is in part covered by the depressor 
anguli oris. It forms the thick part of the chin, and has 
its fibres interwoven with fat. 

Use. To pull the under lip downward. 

10. The Buccinator — Arises, tendinous and fleshy, 
from the lower jaw as far back as the root of the coro- 
noid process ; from the upper jaw, as far back as the 
pterygoid process of the sphenoid bone; it then continues 
to arise from the alveolar processes of both jaws, as far 
forward as the dentes cuspidati. The fibres run forward, 
and are 

Inserted into the angle of the mouth. 

Situation. This muscle lies deep, adheres to the mem- 
brane that lines the mouth; and a quantity of fat is 
always found between its fibres and the other muscles 

2* 



13 



9. 
10. 
11. 
12. 
13. 
14. 



PRACTICAL ANATOMY. 

Fig. 1. 




Muscles of the Face. 



Frontal portion of the Occipi- 
to-Frontalis. 

Its Posterior or Occipital por- 
tion. 

Its Aponeurosis. 

Orbicularis Palpebrae, which 
conceals the Corrugator 
Supercilli, and Tensor 
Tarsi of Horner. 

Pyramidalis Nasi. 

Compressor Naris. 

Orbicularis Oris. 

Levator Labii Superioris 
Alaeque Nasi. 

Levator Labii Superioris. 

Zygomaticus Minor. 

Zygomaticus Major. 

Depressor Labii Inferioris. 

Depressor Anguli Oris. 

Levator Labii Inferioris. 



15. Superficial Portion of the 

Masseter. 

16. Its Deep Portion. 

17. Attrahens. 

18. Buccinator. 

19. Attollens Auriculae Muscle. 

20. Temporal Aponeurosis which 

conceals the Temporal 
Muscle. 

21. Retrahens Auriculae Muscle. 

22. Anterior Belly of the Digas- 

tric — the Tendon is seen 
passing through the Loop 
formed by the Cervical 
Fascia. 

23. Stylo-hyoid Muscle. 

24. Mylo-hyoid Muscle. 

25. Sterno-mastoid Muscle. 

26. Upper part of the Trapezius 

— the Muscle between 25 
and 26 is the Splenius. 



and integuments. It is partly concealed by the masseter, 
and by the muscles which pass to the angle of the mouth, 
as the levator and depressor anguli oris, and zygomaticus 
major. It is inserted behind these muscles. In the 
cheek it is connected with the platysma myoides. 



MUSCLES OF THE FACE. 19 

Use. To draw the angle of the mouth backward and 
outward, and to contract its cavity, by pressing the 
cheek inward. 

The single muscle is the 

Orbicularis Oris. — It consists of two planes of semi- 
circular fibres, which decussate at the angles of the 
mouth. These fibres are formed chiefly by the muscles 
which are inserted into the lips; they surround the 
mouth. The superior portion runs along the upper lip, 
the inferior portion along the under lip. 

Situation. It is connected and intermixed with the in- 
sertions of all the preceding muscles of the face. Some 
of the fibres are connected to the septum nasi, and are 
by Albinus termed Nasalis Labii Superioris. 

Use. To shut the mouth by contracting and drawing 
both lips together. 

At this stage of the examination the Facial Artery 
will be brought into view, a branch of the external 
carotid mounting over the lower jaw in front of the 
masseter muscle, passing under the depressor anguli 
oris and ascending as high as the angle of the eye, where 
it is called Angular Artery. Its branches, enumerated 
from below upward, are as follows: Masseter branches 
to the masseter and buccinator muscles. Inferior La- 
bial to muscles of the lower lip. Inferior Coronary 
to edge of lower lip. Superior Coronary along the 
edge of the upper lip. Lateralis Nasi to the ala and 
septum of the nose. Nerves. — Anterior Dental, 
some distance back from the symphysis of the lower 
jaw, comes out of the anterior dental foramen, and is 
the termination of the inferior maxillary or 3d branch 
of the 5th pair. Any filaments coming forward from the 
outer portion of the face are from the portio dura of the 
7th pair. 

11. Depressor Labii Superioris Al^eque Nasi — 
Arises, thin and fleshy, from the os maxillare superius, 
where it forms the alveoli of the dentes incisiva and dens 
caninus; thence it runs up under part of the levator 
labii superioris ateque nasi. 

Inserted into the upper lip and root of the ala nasi. 



20 PRACTICAL ANATOMY. 

Situation. It is concealed by the orbicularis oris and 
levator labii superioris alaeque nasi. It may be discovered 
by inverting the upper lip, and dissecting on the side of 
the frsenum, which connects the lip to the gums. 

Use. To draw the upper lip and ala nasi downward 
and backward. 

12. The Levator Labii Inferioris — Arises from 
the lower jaw at the root of the alveolus of the lateral 
incisor. 

Inserted into the under lip and the skin of the chin. 

Situation. Those two small muscles are found by the 
side of the frsenum of the lower lip. They lie under the 
depressor labii inferioris. 

On the side of the face we observe two strong mus- 
cles, and two other muscles are concealed by the angle 
of the inferior maxilla. 

Behind the masseter and overlaying a portion of it is 
the Parotid Gland (a salivary gland). It is wedged in 
between the angle and ramus of the jaw and the carti- 
lage of the ear, extending up as high as the zygoma, and 
down into the neck. Its deep surface rests upon the 
styloid process of the temporal bone and is insinuated 
into all the irregularities about this point: its color is 
pinkish, and consists of lobules held together by cellular 
tissue. It has no proper capsule, but is covered by the 
extension of the fascia of the neck. The external 
carotid artery runs through its substance, giving it 
many branches, called Parotidean. The Portio 
Dura, or facial nerve, after it escapes from the stylo- 
mastoid foramen, passes through it also on its way to 
the face, and its several branches form a looped con- 
nection over the masseter called the Pes Anserinus. 
From the anterior and upper part, a white canal (some- 
times two for a little way) passes forward over the mas- 
seter muscle to its anterior edge, beneath which it dips, 
and, perforating the buccinator, empties into the mouth 
opposite the 2d molar of the upper jaw. This is the 
Parotid Duct (duct of Steno). It is accompanied by 
branches of the portio dura nerve, and the Transverse 
Facial Artery from the external carotid. 



MUSCLES OF THE FACE. 21 

1. The Masseter is divided into two portions, "which 
decussate one another. 

The Anterior Portion arises, tendinous and fleshy, 
from the superior maxillary bone, where it joins the os 
malse; from the lower edge of the os malge, and from its 
zygomatic process. The strong fibres run obliquely 
downward and backward, and are inserted into the outer 
surface of the side of the lower jaw, extending as far 
back as its angle. 

The Posterior Portion arises, principally fleshy, from 
the inferior surface of the os malae, and of the whole of 
the zygomatic process, as far back as the tubercle before 
the socket for the condyle of the lower jaw. The fibres 
slant forward, and are inserted, tendinous, into the outer 
surface of the coronoid process of the lower jaw. 

Situation. The anterior portion conceals almost the 
whole of the posterior portion. The greater part of this 
muscle is superficial. Below it is covered by the pla- 
tysma myoides ; and above, a small portion of it is con- 
cealed by the origin of the zygomaticus major. 

Use. To pull the lower to the upper jaw, and to move 
it forward and backward. 

2. Temporalis — Arises, fleshy, from a semicircular 
ridge in the lower and lateral part of the parietal bone, 
from all the squamous portion of the temporal bone, 
from the external angular process of the os frontis, from 
the temporal process of the sphenoid bone, and from an 
aponeurosis which covers the muscle. From these dif- 
ferent origins the fibres converge, descend under the 
bony jugum formed by the zygomatic processes of the 
temporal and cheek bones. 

Inserted, by a strong tendon, into the upper part of 
the coronoid process of the lower jaw, to which it ad- 
heres on every side, but more particularly its forepart, 
where the insertion is continued down to near the last 
dens molaris. If the zygoma is removed, a better view 
will be had. 

Situation. This muscle is of a semicircular shape. It 
is covered by a fascia or aponeurosis. This fascia ad- 
heres to the bones which give origin to the upper part 



90 



PRACTICAL ANATOMY. 



of the muscle, and descending over it, is inserted into 
the jugum and adjoining part of the os malse and os 
frontis. This insertion is by two leaves, leaving a space 
between containing some fat. The temporalis, at its 
origin, lies under the expanded tendon of the occipito- 
frontalis, and under the small tendons which move the 
external ear. Its insertion is concealed by the jugum 
and by the masseter; so that, to expose it, the masseter 
must be cut away. 

Use. To pull the lower jaw upward and press it 

against the upper. 

Fig. 2. 

The two Pterygoid Muscles. The Zygomatic Arch and the 
greater part of the ramus of the lower jaw have been 
removed, in order to bring these muscles into view. 




1. The Sphenoid Origin of the 

External Pterygoid Muscle. 

2. Its Pterygoid Origin. 

3. The Internal Pterygoid Mus- 

cle. 



In order to expose the following muscles, we must re- 
move the muscles of the cheek and jaw, the masseter 
and insertion of the temporalis must be taken away, and 
the coronoid process of the inferior maxilla removed by 
a saw. 

3. The Pterygoideus Externus — Arises from the 
outer side of the external plate of the pterygoid process 
of the sphenoid bone, from part of the tuberosity of the 
os maxillare adjoining to it, and from the root of the 
temporal process of the sphenoid bone. It passes back- 
ward and outward, to be 

Inserted into a depression in the neck of the condy- 
loid process of the lower jaw, and into the anterior and 
inner part of the ligament of the articulation of that 
bone. 



ARTERIES OF THE FACE. 23 

Situation. This muscle passes almost transversely 
from the skull to its insertion. It is concealed by the 
muscles of the face and neck, and by the ascending 
processes of the lower jaw. 

Use. When this pair of muscles act together, they 
bring the jaw horizontally forward. When they act 
singly, the jaw is moved forward, and to the opposite 
side. 

4. The Pterygoideus Internus — Arises, tendinous 
and fleshy, from the inner and upper part of the internal 
plate of the pterygoid process of the sphenoid bone, 
rilling all the space between the two plates ; and from 
the pterygoid process of the os palati between these 
plates. 

Inserted, by tendinous and fleshy fibres, into the in- 
side of the angle of the lower jaw. 

Situation. To expose this muscle, the jaw must be re- 
moved from its articulating cavity, and then pulled for- 
ward, and toward the opposite side; or it may be sawn 
across at its symphysis, and the other half removed. It 
is larger than the pterygoideus externus; and between 
thetwo muscles there is a considerable quantity of cellu- 
lar membrane, and the trunk of the Inferior Maxil- 
lary and Gustatory Nerves. Like that muscle, it is 
concealed by the lower jaw and facial muscles. Along 
its posterior edge, we observe the Ligamentum Laterale 
Maxillae Inferioris, a ligamentous band, which extends 
from the back part of the styloid process to the angle 
of the lower jaw. 

Use. To draw the jaw upward, and obliquely toward 
the opposite side. 

Arteries. 

The External Carotid is found ascending behind the 
parotid gland. It perforates the gland at its upper 
part, ascends over the zygomatic process immediately 
before the ear, and divides into the anterior, middle, and 
posterior temporal arteries, which ramify over the side 
of the head, giving also branches to the forehead and 
occiput. 



24 



PRACTICAL ANATOMY. 



The Internal Maxillary passes behind the condy- 
loid process of the lower jaw; it directs its course to- 
ward the bottom of the orbit of the eye ; and it is at this 
point that it sends off its numerous branches. (1) 
Arteria Media Durje Matris passes through the 
spinal hole of the sphenoid bone into the cranium, and 
is distributed to the dura mater. (2) A. Maxillaris 
Inferior, or Inferior Dental, runs downward, enters the 
foramen at the root of the ascending processes of the 
lower jaw, then passes through the canal of the lower 
jaw; supplying the teeth and sockets, and emerges by 
the foramen mentale, to be distributed to the chin. It 
is accompanied by a nerve and one or two veins. (3) 
A. Pterygoide^e and A. Temporales Profunda are 
small branches of the internal maxillary which pass to 
the pterygoid muscles, and to the inner part of the 
temporal muscle. (4) A. Pharynge^:, branches to the 
pharynx, palate, and base of the skull. (5) A. Alveo- 
laris, which gives branches to the teeth of the upper 
jaw, and to the jaw bone itself. (6) A Branch (spheno- 
palatine) through the foramen spheno-palatinum to the 
nose; and (7) An Artery through the palato-maxillary 
canal to the palate. 

Fig. 3. 
The Internal Maxillary Artery and its Branches. 




A. External Carotid Artery. 

a. Internal Maxillary Artery. 

b. Arteria Tympanica. 

c. Arteria Pterygoidea. 
Dentalis Inferior. 
Arteria Meningea Parva. 
Arteria Buccalis. 
Arteria Alveolaris, or Max- 
illaris Superior. 

Arteria Meningea Magna. 
Infra-Orbitalis. 
Anterior Mental Artery. 



The continued trunk of the internal maxillary enters 
the orbit by the spheno-maxillary slit. It sends off a 



NERVES OF THE FACE. 25 

branch which runs along the inner side of the orbit, and 
passes out at the inner canthus of the eye on the fore- 
head. The artery itself runs along the bottom of the 
orbit in a canal on the upper part of the great tuber- 
osity of the os maxillare superius, and emerges by the 
foramen infra-orbitarium on the face; hence it is termed 
A. Infra- Orbitaria, and is distributed to the cheek and 
side of the nose. 

The Frontal Artery is also seen in the dissection 
of the face, passing from the orbit through the foramen 
supra-orbitarium to be distributed to the forehead. This 
artery is sent off from the ophthalmic artery, which is a 
branch of the internal carotid. 

If the face be injected, a remarkable anastomosis of 
arteries will be observed at the inner angle of the eye. 

Veins. 

The veins of the face are numerous, and pass into the 
external and internal jugular veins. 

fflerves. 

1. The Portio Dura of the seventh pair, Nervus 
Communicans Faciei, or Facial nerve, after its course 
through the temporal bone in the aqueduct of Fallopius, 
comes out by the foramen stylo-mastoideum. It imme- 
diately gives off branches to the neighboring parts, as 
behind the ear. It then passes through the substance of 
the parotid gland, and emerges on the face in three great 
branches, which have frequent mutual communications : 
this division of the nerve is called Pes Anserinus. 

(1) The ascending branch ramifies on the temple and 
forehead. 

(2) The middle branch sends its ramifications over the 
side of the face, the proper Facial Nerves. 

(3) The descending branch sends its twigs along the 
chin, down upon the neck, and backward upon the 
occiput. 

2. The Superior Cervical Nerves send off several 



26 



PRACTICAL ANATOMY. 
Fig. 4. 




The Distribution of the Facial Nerve and the Branches of 
the Cervical Plexus. 

1. The Facial Nerve (Portio Dura) escaping from the Stylo-mast oid 

Foramen, and crossing the Ramus of the Lower Jaw; the 
Parotid Gland has been removed, in order to show the Nerve 
more distinctly. 

2. The posterior Auricular Branch ; the Digastric and Stylo-mastoid 

Filaments are seen near the origin of this branch. 

3. Temporal Branches communicating with (4) the Branches of the 

Frontal Nerve. 

5. Facial Branches communicating with (6) the Infra-orbital Nerve. 

7. Facial Branches communicating with (8) the Mental Nerve. 

9. Cervico- facial Branches communicating with (10) the Superficial 
Cervical Nerve, and forming a Plexus (11) over the Submax- 
illary Gland. The distribution of the branches of the facial 
in a radiated direction over the side of the face, and their 
looped communications, constitute the Pes Anserinus. 

12. The large Auricular Nerve, one of the Ascending Branches of 

the Cervical Plexus. 

13. The Small Occipital ascending along the Posterior Border of the 

Sterno-mastoid Muscle. 

14. The Superficial and Deep-descending Branches of the Cervical 

Plexus. 

15. The Spinal Accessory Nerve, giving off a Branch to the External 

Surface of the Trapezius Muscle. 

16. The Large Occipital Nerve, the Posterior Branch of the second 

Cervical Nerve. 



NERVES OF THE FACE. 27 

branches, which ramify on the side of the face and head, 
and communicate freely with the branches of the portio 
dura. 

As, in the course of this dissection, we meet with many 
twigs of the second and third branches of the fifth pair 
of nerves, it will be advisable here to describe this pair 
of nerves. 

1st. The Ophthalmic Nerve. The first branch of the 
fifth pair enters the orbit through the sphenoidal fissure. 
Its branches are the Frontal, which, passing above the 
levator palpebral muscles, escapes upon the forehead 
through the supra-orbital foramen. The Lachrymal 
passes along the upper edge of the external rectus mus- 
cle with the Lachrymal Artery to the Lachrymal 
GLx\nd. Here it divides into two branches, one escaping 
through the malar bone upon the cheek and temple, the 
other to the under part of the gland, and conjunctiva of 
the upper lid. 

The Nasal passes between the origins of the external 
rectus muscle, accompanies the ophthalmic artery and 
enters the anterior ethmoidal foramen, then up through 
the ethmoid bone to the cribriform plate, and then through 
the nasal slit in that plate into the nose, which supplies 
the mucous membrane and integuments of the nose. Its 
principal branches while in the orbit are the Ganglionic, 
Ciliary, and infra-trochlear. 

3. Nervus Maxillaris Superior, or second branch 
of the fifth pair. The superior maxillary nerve, having 
left the cranium by the foramen rotundum of the sphe- 
noid bone, emerges behind the antrum maxillare, at the 
lower back part of the orbit, and at the root of the ptery- 
goid process of the sphenoid bone. It immediately sends 
out branches: 1. A small branch which passes through 
the spheno-maxillary slit to the periosteum and fat of the 
orbit. 2. The largest branch is the Infra-Orbitary 
Nerve. It enters the channel in the top of the antrum 
maxillare, accompanying the infra-orbitary artery, comes 
out at the foramen infra-orbitarium, and is widely dis- 
tributed to the cheek, under lip, and outside of the nose, 
communicating with ramifications of the portio dura. 



28 PRACTICAL ANATOMY. 

3. Branches to the temporal muscle, os malse, etc. 4. 
Communicating branches with Meckel's ganglion. 5. 
Posterior dental branches through the foramina in the 
superior maxillary bone. 6. Twigs which supply the 
gums and alveoli of the upper jaw. 

4. Nervus Maxillaris Inferior, or third branch of 
the fifth pair. The inferior maxillary nerve leaves the 
cranium by the foramen ovale of the sphenoid bone. It 
has its course downward and outward ; and, having given 
twigs to the parts near which it passes, as the masseter, 
pterygoid, and temporal muscles, it divides at the angle 
of the jaw into two branches. 

1. Inferior Dental Nerve — Enters the foramen at 
the angle of the lower jaw, accompanies the Inferior 
Dental Artery along the canal in that bone, giving 
nerves to the teeth, emerges at the anterior mental fora- 
men, and is distributed to the chin. 

2. The Gustatory or Lingual Nerve passes to the 
tongue. It lies close along the inner surface of the lower 
jaw, below the inferior edge of the pterygoideus-internus, 
and above the mylo-hyoid will be seen when the neck is 
dissected. This nerve receives the chorda tympani. 

3. The Frontal Nerve, which comes from the first 
branch of the fifth pair through the supra- orbital fora- 
men: it is distributed to the forehead. 

A general view of the distribution of the spinal nerves 
may be usefully subjoined in this place, to complete the 
description of the nerves. 

1. The Cervical Nerves consist of eight pairs ; they 
spread their branches over the side and back of the neck 
and head, and to the muscles moving the head and 
shoulders. The superior nerves send branches to the 
sides of the head, and the inferior to the upper part of 
the chest and back. They also communicate freely with 
each other, and with all the neighboring nerves ; — high 
in the neck, and under the jaw, with the portio dura of 
the seventh pair, with the fifth, eighth, and ninth pairs, 
and with the great sympathetic; — toward the middle of 
the neck, with the descendens noni, the sympathetic and 
eighth pair, and in the lower part of the neck with the 
sympathetic. 



THE SPINAL NERVES. 29 

The Phrenic Nerve is formed by branches of the 
third, fourth, and fifth cervical nerves, passes obliquely 
down the neck through the thorax, then on each side of 
the pericardium, and is distributed to the diaphragm. 

The Axillary Plexus is formed by the principal 
parts of the trunks of the fourth, fifth, sixth, and seventh 
cervical, and first dorsal nerves. 

2. The Dorsal Nerves are twelve pairs. They arise 
from the spinal marrow in the same manner as the cervi- 
cal. Each nerve emerges betwixt the heads of the ribs, 
gives twigs to the great sympathetic nerve, and twigs 
which pierce backward to the muscles of the back ; then 
entering the groove in the lower edge of each rib, it ac- 
companies the intercostal artery, and runs toward the 
anterior part of the thorax, supplying the great muscles 
of the chest, giving twigs to the diaphragm, and muscles 
of the abdomen. 

3. The Lumbar Nerves are five pairs. They arise 
in the same manner; their trunks are covered by the 
psoas magnus muscle. Each nerve gives twigs to the 
muscles of the loins and back, and to the sympathetic 
nerves, and runs obliquely downward to supply the ab- 
dominal muscles and integuments of the groin and scro- 
tum; but the trunks of these nerves assist in forming 
the nerves of the thigh. 

4. The Sacral Nerves are five on each side, arising 
from the cauda equina. They come out through the 
anterior foramina, and send small branches to the neigh- 
boring parts; but the great trunks of these nerves are 
united with the lumbar nerves, to form the nerves of the 
lower extremity, viz.: 

(1) The Anterior Crural Nerve, passing out 
under Poupart's ligament to the extensor muscles of the 
leg, is formed by branches of the first, second, third, and 
fourth lumbar nerves. 

(2) The Obturator Nerve, leaving the pelvis by 
the thyroid holes, and being distributed to the deep- 
seated muscles on the inside of the thigh, arises from 
branches of the second, third, and fourth lumbar nerves. 

(3) The Ischiatic or Sciatic Nerve, the greatest 



30 PRACTICAL ANATOMY. 

nerve of the body, passes out from the back part of the 
pelvis, through the sacro-sciatic notch, and takes its 
course along the back of the thigh, to supply the thigh, 
leg, and foot; it is formed from the two last nerves of 
the loins and three first of the sacrum. 

All these nerves of the spine communicate freely by 
numerous twigs, and by the intervention of 

The Great Sympathetic Nerve, or Intercostal. — 
This nerve, consisting of ganglia connected by cords, 
passes out of the cranium with the carotid artery. It 
then descends through the neck, and forms three gan- 
glions in its course, which give twigs to the neighboring 
parts, and are joined by filaments from the cervical 
nerves, and the eighth and ninth pairs. The intercostal 
then enters the thorax, and descends by the side of the 
vertebra, behind the pleura, giving filaments, which, 
joining with twigs of the eighth pair, form several plex- 
uses to supply the heart, lungs, etc. In the abdomen it 
descends on the lumbar vertebrae, and at last terminates 
in the pelvis on the extremity of the coccyx. 

While in the thorax, it gives off a branch, which, 
uniting with branches of the dorsal nerves, forms 

The Anterior Intercostal, or Splanchnic Nerve. 
— This nerve, passing betwixt the crura of the dia- 
phragm, enters the abdomen, forms the semilunar gan- 
glion, and is distributed by numerous plexuses to all the 
abdominal viscera. 

The eighth pair, or par vagum, has also a very long 
course; it arises in the head, passes through the neck, to 
which it gives several branches. It enters the thorax 
anterior to the subclavian artery; here it gives off a 
remarkable branch, called the Recurrent, because it is 
reflected round the arch of the aorta on the left side, 
and round the subclavian artery on the right, and as- 
cends to be distributed on the trachea, oesophagus, and 
larynx. The nerve then passes through the thorax, and, 
entering the abdomen, terminates in the stomach; in 
this course it has frequent communications with the 
great sympathetic, which it assists in forming the dif- 
ferent plexuses that supply the thoracic and abdominal 



THE NOSE. 



31 



viscera. It is distributed to the heart, lungs, liver, 
spleen, stomach, and duodenum. 



The Nose. 

The two openings in front are the Nostrils guarded 
by stiff hairs (Vibrissas). The septum between the nos- 
trils, the Columna; the tip of the nose, the Lobulus ; 
sides (Al^;). It is covered with great numbers of seba- 
ceous follicles : its form secured by five fibro-cartilages. 

1. Fibro-Cartilage or the Septum divides partly 
the nasal fossae into two. 

2. Lateral Fibro-Cartilage (2) connected above 
to the nasal bones and nasal process of superior maxil- 
lary, and below to the alar fibro-cartilage. 

3. Alar Fibro-Cartilages (two); each is curved 
to correspond to the nostril. The inner portion of each 

Fig. 5. 

The Nasal Cartilages, showing their Connection with each 
other and with the ossi nasi. 



/^T> 



1. Cartilage of the Septnm. 
2, 2. Lateral Cartilages. 

3. Ala Cartilage. 

4. Corima, or Appendices of the Ala 

Cartilage. 

5. Nostril. 




coming together form the columna. The alse are ex- 
tended by three or four fibrocartilaginous appendages. 



32 PRACTICAL ANATOMY. 



CHAPTER IV. 

OF THE CONTENTS OF THE CRANIUM, OR THE BRAIN 
AND ITS MEMBRANES. 

A transverse incision, extending from ear to ear 
over the crown of the head, being made through the 
tendon of the occipito-frontalis, the two flaps may, with 
facility, be inverted on the face and neck. Remove the 
superior part of the cranium by a saw directed anteriorly 
through the frontal bone above the orbitar process, and 
posteriorly as low as the transverse ridge of the occipital 
bone. Thus the subsequent demonstration of the brain 
will be conducted with greater facility. 

When the superior part of the cranium, commonly 
called the Calvarium, or skull cap, is torn off, which re- 
quires considerable force, you expose the Dura Mater, a 
firm, compact, and whitish membrane, somewhat shining, 
rough on its outer surface, from the rupture of vessels 
which connected it to the cranium, and covered with 
bloody spots in consequence of the blood effused from 
these ruptured orifices. It is described as being separa- 
ble into many laminse (into two with facility) ; and it is 
said that these two laminae, by separating and reuniting, 
form the triangular cavities named Sinuses, which are 
in fact large veins. This division of layers ean hardly be 
admitted as correct in the recent state of the membrane. 

The Superior Longitudinal Sinus lies in a groove 
formed by the two parietal bones ; it extends along the 
sagittal suture from the crista galli of the ethmoid bone 
to the middle of the os occipitis, where it bifurcates into 
the two lateral sinuses; in its passage backward, its size 
is increased. When slit open (which it should be), its 
triangular form is evident; it is lined by a smooth mem- 
brane, and in it may be remarked the numerous open- 
ings of the veins of the pia mater opening forward, the 



CONTENTS OF THE CRANIUM. 



33 



frena, or slips of fibres crossing from side to side, called 
Chords Willisii, glandulse Pacchioni interna, et ex- 
terna, little bodies like millet-seed seen on the outer 
and inner surface of the sinus. 




Sinuses of the Dura Mater. 



1. Superior Longitudinal Sinus. 

2. Inferior Longitudinal Sinus. 

3. The two Venae Galeni. 

4. Sinus Quartus. 

5. Torcular Herophili. 

i 6. The Lateral Sinuses. 
7. Inferior Petrous Sinus. 



8. Superior Petrous Sinus. 

9. Circular Sinus of Ridley. 

10. The two occipital Sinuses. 

11. Cavernous Sinus. 

12. Internal Jugular Veins. 

13. Veins of the Pia Mater. 



The arteries of the dura mater are divided into the 
anterior, middle, and posterior. 

1. Arteria Meningea Media (called also the Spi- 
nalis or Spheno-spinalis), the great middle artery, is a 
branch of the internal maxillary; it passes through the 
spinous hole of the sphenoid bone, and is seen arising 
from the anterior inferior angle of the parietal bone (in 
a groove on which it lies), and spreading its numerous 
branches over the dura mater. 

3 



34 PRACTICAL ANATOMY. 

The anterior and posterior arteries are small. 

2. A. Meningea Anterior is sent off from the ex- 
ternal carotid, and enters the cranium by the foramen 
lacerum orbitale superius. 

3. A. Meningea Posterior is given off by the verte- 
bral artery; the dura mater also receives small twigs 
from the occipital, pharyngeal arteries, etc. 

Of the Septa of the Brain, or Processes of the Dura 
Mater. 

1. The Falx (cerebri or major) is a long and broad 
fold, or duplicature of the inner lamina of the dura mater, 
dividing the cerebrum into two hemispheres, extending 
from the crista galli of the ethmoid bone, along the 
middle of the os frontis and point of junction of the two 
parietal bones, to the crucial ridge of the occipital bone, 
where it terminates in the middle of the next septum. 

2. The Tentorium Cerebelli, or transverse septum. 
This separates the cerebrum from the cerebellum, and is 
formed by the inner lamina of the dura mater, reflected 
off from the os occipitis along the groove of the lateral 
sinuses, and the edge or angle of the temporal bones. 
Its position is horizontal. 

There are some other folds of the dura mater not visi- 
ble in this stage of the dissection. 

3. The falx of the cerebellum, or small occipital sep- 
tum, will be seen when the cerebrum is removed. It ex- 
tends from the middle of the tentorium along the middle 
spine of the os occipitis to the foramen magnum, dividing 
the cerebellum into two parts. 

4. The sphenoidal folds, two small folds of the dura 
mater, one on each side of the sella turcica, stretching 
from the posterior to the anterior clinoid processes. 

The dura mater, also, in many parts of the brain, sepa- 
rates its laminae to form sinuses; the principal of these 
will be noticed in the course of the dissection. This 
membrane should now be divided in the line of the divi- 
sion of the cranium ; its internal surface is smooth, glisten- 
ing, and free from adhesion, except in the course of the 



THE DURA MATER. 



35 



longitudinal sinus ; into which veins pass from the pia 
mater. 

Fig. 7. 




Oblique View of the Interior of the Cranium as lined by 
the Dura Mater. 



1. Falciform Process. 

2. Its Superior or Attached Border containing the Longitudinal 

Sinus. 

3. Its Free Border. 

4. Continuation of the Falciform Process with (6) the Tentorium. 
7, 8. Free Concave Edge of the Tentorium. 

9. Termination of this edge at the Anterior Clinoid Process. 
10. Attached Border of the Tentorium continued along the Upper 
Angle of the Petrous Bone to the Posterior Clinoid Process. 

Detach the falx from the crista galli, and turn it 
backward, observe in its lower edge the Inferior Longi- 
tudinal Sinus, which enters a sinus in the tentorium, 
termed the Straight Sinus. This will fully expose the 
convolutions of the brain, which are closely invested by 
the pia mater. 

1. The Tunica Arachnoidbs is a fine membrane, 
covering uniformly the surface of the pia mater, with- 



36 PRACTICAL ANATOMY. 

out passing into the interstices of its duplicatures. It 
is attached to it, is extremely thin, transparent, without 
vessels, demonstrated with difficulty on the upper sur- 
face of the brain by the blowpipe (which raises it into 
cells), but on the base of the brain it can be distinctly 
seen. 

2. The proper Pia Mater, or tunica vasculosa, is a 
very vascular membrane, transparent in the interstices 
of its vessels, investing the substance of the brain, de- 
scending betwixt all its convolutions, and lining its dif- 
ferent cavities; but, where it lines the ventricles, it is 
fine, delicate, and less vascular than on the surface and 
betwixt the convolutions of the brain. It is connected 
to the dura mater by its veins passing into the longitu- 
dinal sinus. 

The brain is divided into three parts: 1. The cere- 
brum ; 2. The cerebellum ; 3. The medulla oblongata. 

The Cerebrum consists of two distinct substances: 

1. The cortical or vesicular substance forming the 
outer part. 

2. The white medullary or tubular substance forming 
the inner part. 

The brain is divided by the falx into two hemispheres, 
and by the pia mater into numerous convolutions. 
Each hemisphere is divided into three lobes. 

1. The Anterior Lobes rest on that part of the cra- 
nium which forms the two orbits, and is called the ante- 
rior fossae of the basis of the cranium. 

2. The Middle Lobes are situated before and above 
the medulla oblongata, and rest on the middle fossae of 
the basis cranii, which are formed by the sphenoid and 
temporal bones. 

3. The Posterior Lobes are supported by the tento- 
rium. 

The anterior and middle lobes are parted by a deep 
narrow sulcus, which ascends obliquely backward from 
the temporal ala of the os sphenoides to near the middle 
of the os parietale; it is termed Fissura Cerebri, or 
Fissura Magna Sylvii. 

By gently separating with the fingers the two hemi- 



THE CEREBRUM. 



37 



spheres of the brain, 1 we see passing betwixt them a 
longitudinal white convex body, the Corpus Callosum: 
it lies under the falx. On the surface of the corpus cal- 

Fig. 8. 




Horizontal Section of the Cerebrum upon a Level with the 
Corpus Callosum. 

1. Outer edge of the Corpus Callosum, formed by pressing aside the 

Medullary Substance of the Hemisphere. 

2. Medullary or Fibrous Substance. 

3. Upper Surface of the Commissure. 

4. Raphe. 

losum is seen the Raphe, between two longitudinal med- 
ullary lines, Linea Longitudinalis Lancisii, united 
by transverse fibres, the Linea Transversa. 

When one hemisphere of the brain is cut horizontally 



1 Between the hemispheres and on the surface of the corpus callo- 
sum, we observe the arteriae callosae, which are the continuation of 
the trunks of the anterior cerebri. 



38 PRACTICAL ANATOMY. 

on the level of the corpus callosum, an appearance is 
produced, termed the Centrum Ovale Minus. When 
both are sliced off to the same level, the Centrum 
Ovale Majus. 

Under this surface are the two lateral ventricles. 1 If 
one of these be cautiously perforated on the side of the 
corpus callosum, and gently inflated by a blowpipe, its 
extent may be seen; but if much force be used, the air 
will pass into the other ventricle. 

The two ventricles are separated by a medullary 
partition, which descends from the inferior surface of 
the corpus callosum to the fornix, the Septum Lucidum; 
it consists of two laminae, with a narrow cavity between 
the Fifth Ventricle. To see this septum, one of the 
ventricles must be laid open, and the septum pulled 
gently to the other side. 

The Lateral Ventricles are two, right and left, 
lined with a fine membrane, narrow, consisting of a 
body, and three prolongations or cornua. 

1. The body is formed betwixt the corpus callosum, 
the medulla of the brain, the convexity of the corpus 
striatum, and the thalamus nervi optici. 

2. The Anterior Cornu, or horn, is formed betwixt 
the more acute convexity of the corpus striatum and 
the anterior part of the corpus callosum. 

3. The Posterior Cornu (called also the digital 
cavity) may be traced stretching backward and down- 
ward into the posterior lobe of the brain. 

4. The inferior or descending cornu cannot be traced 
in this stage of the dissection; it seems like the con- 
tinued cavity of the ventricle, takes a curve backward 
and outward, and then, turning forward, descends into 
the middle lobe of the brain. 

The lateral ventricles communicate with each other, 



1 To show the lateral ventricles, the corpus callosum should be cut 
away close to the septum lucidum, and then the ventricle of that 
body, and the thickness and breadth of the septum itself, will be 
more clearly seen. 



THE FORNIX. 39 

and with the third ventricle, by an opening under the 
forepart of the arch of the fornix. 1 

In the lateral ventricles we meet with 

The Fornix, a medullary body, flat and of a triangu- 
lar shape, broadest behind, which divides the two lateral 
and the third ventricles. It is exposed on tearing away 
the septum lucidum; its lower surface is toward the 
third ventricle; its lateral margins are in the lateral 
ventricles; on its upper surface it supports the septum 
lucidum, and under its most anterior part is the foramen 
Monroianum. One of the angles of this body is forward, 
and the other two toward the back part: it rests chiefly 
on the thalami nervorum opticorum, but is separated 
from them by a vascular membrane called the velum 
interpositum. 

The extremities of the body of the fornix are named 
its Crura. 

1. The crus anterius is double, bends downward be- 
fore the anterior commissure of the brain, with which it 
is connected, and may be traced into the corpora albi- 
cantia, and tuber cinereum on the base of brain. 

2. The two crura posteriora, coalescing with the back 
part of the corpus callosum, pass, on each side, into the 
inferior cornu of the lateral ventricle, and terminate on 
the hippocampus major. 

Divide the body of the fornix, invert it, by turning 
the anterior crus forward, and the posterior crura back- 
ward; on the under surface of the latter is an appear- 
ance of transverse lines, named Corpus Psalloides, psal- 
terium, or lyra. 

The inversion of the fornix exposes 

1 It has been doubted whether or not this be an opening; the 
choroid plexus passes through it, and seems to unite the surfaces ; 
it is absurdly named the Foramen Monroianum, from a mistaken 
notion that Dr. Munro discovered it, and may be seen by gently 
turning the anterior crus of the fornix to one side ; it is a space be- 
twixt the most anterior part of the convexity of the thalami nervo- 
rum opticorum, and the anterior crus of the fornix. 

This foramen may always be easily found by following the course 
of the plexus choroides, as it passes forward in the ventricle. It is 
a slit, rather than a round hole, in the natural state. 



40 



PRACTICAL ANATOMY. 



The Plexus Choroides. — This is a continuation of 
the pia mater, a spongy mass, consisting of folds of tor- 
Fig. 9. 




A Transverse Section of the Brain, showing the Corpora 
Striata, Lateral Ventricles, and the Associated Parts. 



1, 1. Medullary portion, of the 
Hemispheres. 

2. Vesicular Neurine or Corti- 

cal Portion. 

3. Corpus Striatum. 

4. Septum LucI lum. 

5. Ventriculus Septi or Fifth 

Ventricle. 
6, 6. The Fornix. 

7. Posterior Crura of the For- 

nix. 

8. Base of the Fornix. 



9, 9. Plexus Choroides, at the 
Margin of the Velum In- 
terpositum. 

10. Anterior Cornu of the Lat- 

eral Ventricle. 

11. Middle or Descending 

Cornu. 

12. Posterior Cornu. 

13. Hippocampus Major. 

14. Taenia Hippocampi. 

15. Hippocampus minor. 

16. Longitudinal Fissure of the 

Brain. 



tuous vessels partly covering the thalami nervorum 
opticorum, and continued into the inferior cornu of the 



THE VULVA. 41 

lateral ventricles. The plexus of each side is connected 
to its fellow by the Velum Interpositum, a membrane 
which passes under the fornix, and lies on the third 
ventricle and corpora quadrigemina. 

From this plexus the blood is received by the Vena 
Galeni situated in the middle of the velum interpositum 
which consists of two parallel branches ; these run back- 
ward, unite, and enter the Torcular Herophili through 
the Sinus Rectus. 

This plexus should now be detached at its forepart, 
and turned back ; it will remain as a guide to the knife 
in tracing the inferior cornu of the lateral ventricle. 

We now see 

The Corpora Striata, two smooth convexities, in 
the forepart of the lateral ventricle, broad, and rounded 
anteriorly, becoming narrow, and diverging as they pass 
backward, consisting of tubular and vesicular substance 
disposed in striae. 

The Thalami Nervorum Opticorum, two large oval 
whitish eminences, placed by the side of each other be- 
tween the diverging extremities or crura of the corpora 
striata; toward their forepart is a peculiar eminence or 
convexity, called the Anterior Tubercle. On the outer 
and posterior face two enlargements, the Corpus Geni- 
culatum Externum and Internum. The former con- 
nected by a ridge to the testes. The latter to the nates. 

Taenia Semicircularis, a white medullary line, 
running in the angle between the corpus striatum and 
thalamus nervi optici of each side. 

Commissura Anterior Cerebri, a short cylindrical 
medullary cord, stretched transversely between the fore 
and lower part of the corpora striata, immediately under 
the anterior crura of the fornix. 

Just above the commissura anterior, and before the 
thalami, is the Vulva, or foramen commune anterius, a 
small slit or indentation, formed by the anterior crus of 
the fornix, bifurcating, and inserting itself, on each side, 
between the corpus striatum and thalamus nervi optici. 
This slit is the space by which the three ventricles com- 
municate. 

3* 



42 PRACTICAL ANATOMY. 

Commissura Mollis is an exceedingly soft, broad, 
cineritious junction between the convex surfaces of the 
thalami nervorum opticorum. 

On separating the optic thalami, we discover the Third 
Ventricle. This is a longitudinal sulcus, or slit, situ- 
ated between the thalami nervorum opticorum, and be- 
tween the crura cerebri. Above, it is covered by the 
fornix and velum interpositum; at its upper and fore- 
part, it communicates with the two lateral ventricles; 
below the commissura anterior, it opens into the infundi- 
bulum. This opening is termed Iter ad Infundibu- 
lum. Backward, it is continued by a canal which passes 
under the tubercula quadrigemina into the fourth ven- 
tricle. This passage is named Iter ad Quartum Ven- 
triculum (aquaeductus Sylvii). 

The Pineal Gland, a small, soft, grayish, and conical 
body, of the size of a pea, is seated above the tubercula 
quadrigemina, and behind the thalami, to which it is con- 
nected by two white pedunculi, or footstalks; its base is 
turned forward, and the apex backward; it is covered 
by the plexus choroides and posterior crura of the fornix. 
It contains an earthy matter, either in its own substance 
or that of the pedunculi, resembling sand. It was named 
by Soemmering, who first discovered that it belongs to 
the healthy structure of the brain, the Acervulus 
Glandule Pinealis. 

Commissura Posterior, a transverse cord at the 
back part of the third ventricle, before the tubercula 
quadrigemina, and above the iter ad quartum ventri- 
culum. 

Tubercula Quadrigemina, four small white bodies, 
adhering together, lying under the pineal gland, be- 
hind the third ventricle, and above the fourth. The 
uppermost two are named Nates, and the other two 
Testes. 

From the under part of the testes, there project back- 
ward two ridges or cords, connecting themselves with 
the crura cerebelli, Processus a Cerebello ad Testes, 
and a thin medullary lamina between the Valve of 

VlEUSSENS. 



THE CEREBRUM. 
Fig. 10. 



43 




A Section of the Cerebrum, showing the Upper Surfaces of 
the Corpora Striata and Optic Thalami, the Cavity of the 
Third Ventricle, and the Upper Surfaces of the Cere- 
bellum. 



Tubercula Quadrigemina. 

Nates. 

Testes. 

Commissura Mollis. 

Anterior Extremity of the 
Corpus Callosura cut. 

Crura of the Fornix. 

Anterior Horn of Lateral 
Ventricle. 

Corpora Striata. 
I, I. Thalami Optici. 
z to s. Third Ventricle. 

In Front of z is the An- 
terior Commissure. 



a. 
e. 
b. 
e. 

f- 
9- 

k, k. 



s. Posterior Commissure. 

p. Pineal Gland with its Pe- 
duncles. 
n, n. Processus e Cerebello ad 

Testes. 
m, m. Hemispheres of the Cere- 
bellum. 

h. Superior Vermiform Pro- 
cess. 

i. Notch between the Hemi- 
spheres of the Cerebel- 
lum behind. 



44 PRACTICAL ANATOMY. 

The inferior cornu of the lateral ventricle, which de- 
scends into the middle lobe of the brain, may now be 
traced, by following the tract of the choroid plexus. 1 
In it is seen 

The Hippocampus Major, or Cornu Ammonis. At 
its commencement it is narrow, but it becomes a broad 
medullary projection of the floor of the ventricle; and 
its extremity, which is called Pes Hippocampi, is curved 
inward. The thin edge on its inside, which follows the 
whole of its circuit, is named the Corpus Fimbriatum, 
or Taenia Hippocampi. Within this body is another, 
resembling the teeth of a comb, the Corpus Dentatum. 
The posterior crus of the fornix runs along its inner and 
anterior part, in the form of a thin floating edge. 

In the posterior cornu of the lateral ventricle, which 
passes into the posterior lobe of the brain, there is a 
similar medullary projection, but smaller, the Hippocam- 
pus Minor. 

Below the iter ad infundibulum are seen the Corpora 
Albicantia Willisii (corpora mammillaria), two medul- 
lary eminences of the size of peas. The remainder of 
these bodies is seen on the outer surface of the base of 
the brain. 

This completes the demonstration of the cerebrum. 
The whole of the posterior lobes and the lateral part of 
the middle lobes may be removed. This exposes to your 
view 

The Tentorium and the Falx Cerebelli. At this 
point you should trace the bifurcation of the longitudinal 
sinus into the two lateral sinuses. The lateral sinuses are 
formed by the splitting of the laminae of the tentorium; 
hence they follow the course of that membrane, run 
along their grooves in the occipital bone, and dip down- 
ward and forward through the foramen lacerum in basi 
cranii, to terminate in the internal jugular veins. 

The Torcular Hlrophili, or fourth sinus, runs 
along the middle of the tentorium, and joins the ex- 



1 Or it. may be exhibited by cutting away successive slices of the 
side of the bvain until the ventricle is exposed. 



THE CEREBELLUM. 45 

tremity of the longitudinal sinus at the point where it 
bifurcates.- 

The great notch of the tentorium is a circular opening 
left on the anterior part of the tentorium, allowing a 
junction between the cerebrum and cerebellum. 

The brain should now be removed by elevating the 
front lobes, and dividing the nerves, arteries, etc., as 
they appear, cutting through the tentorium as it stretches 
along the Petrous bone, and, pushing the knife through 
the great occipital foramen, divide the spinal marrow and 
vertebral arteries, when it may be turned out and in- 
verted. Clean it off well, leaving the nerves. Its under 
surface exhibits the Anterior and Middle lobes of the 
cerebrum, the two hemispheres of the cerebellum, the 
Pons Varolii, or Tuber Annulare, and Medulla 
Oblongata. 

Cerebellum. — This part of the brain, divided into 
two lobes by the falx cerebelli, or septum occipitale, is 
covered by a vascular membrane; consists of medullary 
and cineritious substance; but, instead of convolutions, 
has numerous deep sulci, into which the pia mater dips, 
and forms thin flat strata. 

Remark the following processes : 

1. Appendix, or Processus Vermiformis Superior, 
situated under the pia mater, on the anterior and supe- 
rior part of the cerebellum, the anterior part the Mon- 
ticulus. 

2. Appendix, or Processus Vermiformis Inferior, 
will be found situated between the two lobes on the 
under surface of the cerebellum, and immediately behind 
the medulla oblongata. 

On separating the two lobes behind, and making a 
deep incision, we discover 

The Fourth Ventricle. — The sides of this ventricle 
are formed by the cerebellum, the anterior part by the 
medulla oblongata, the upper and back part by the val- 
vula cerebri; it is lined by a thin vascular membrane, 
and has on its forepart a groove or fissure, which, term- 
inating in a sharp point, is named Calamus Scripto- 
Rius. On each side of this groove are seen several 



46 



PRACTICAL ANATOMY. 



medullary lines, which are the origin of the portio mollis 
of the seventh pair of nerves. The iter a tertio ad 




A Posterior View or the Cerebellum, and the several Lobules 
of which it is composed. (After Solly.) 



1. Spinal Cord. 

2. Posterior Spinal Nerves. 

3. Amygdaloid Lobule. 

4. Lobulus Pneumogastrici. 

5. Lobulus Gracilis. 

6. Inferior Semilunar Lobe. 



7. Superior Semilunar Lobule. 

8. Lobulus Quadratus. 

9. Superior Vermiform Process. 

10. Vermis Inferior. 

11. Monticulus. 



quartum ventriculum enters the upper part of the fourth 
ventricle. The valve of Vieussens hangs over it. 

On cutting the cerebellum perpendicularly, there is 
formed, from the intermixture of cineritious and medul- 
lary matter, a tree-like appearance, named Arbor Vit,e, 
of which the trunk is termed the peduncle of the cere- 
bellum, and is continued to the back part of the medulla 
oblongata. 

On the under surface is a gutter into which projects 
the Inferior Vermiform Process — the Vallecula. 
This leads to the fourth ventricle, on each side of which 
and in the centre are lobes. The lateral ones called the 
Amygdala, the intermediate one the Uvula. Another 
on the restiform body, the Flocculus. 



THE MEDULLA OBLONGATA. 



47 



Fissures of Sylvius — Separate the anterior from 
the middle lobe of the cerebrum. 

Fig. 12. 
Anterior Aspect of the Medulla Oblongata. 



1. Corpora Pyramidalia. 

2. The point of their Decussa- 

tion. 

3. Corpora Olivaria. 

4. Fibres that run from the 

Anterior Column of the 
Medulla Spinalis to the 
Cerebellum. 

5. Corpora Restiformia. 

6. Arciform Fibres. 

7. Anterior Columns. 

8. Lateral Columns. 
9, 10. Pons Varolii. 

11. Roots of the Trigeminus 
Nerve. 



Medulla Oblongata — Upper end of the Medulla 
Spinalis. On it a median fissure ; three bodies on each 
side. One next to the fissure Corpus Pyramidale; 
next the Olivaris, next the Restiforme. 

Pons Varolii — The body at the top of the Medulla 
Oblongata. Basilar Artery rests upon its middle. 

Crura Cerebelli — Thick cords from the Pons to 
the cerebellum. 

Crura Cerebri — Round cords passing in a divergent 
manner, from the Pons to the cerebrum. 

Corpora Mammillaria or Albicantia — Two little 
round bodies between the crura, front of the Pons. 

Locus Perforatus — Perforated space between the 
last named bodies and the Pons. 

Tuber Cinereum or Pons Tarini — Triangular space 
in front of the corpora albicantia : a little process in its 
centre, the Infundibulum. In front the commissure of 
the optic nerves. 




48 



PRACTICAL ANATOMY. 
Fig. 13. 




Base of the Brain. A, Anterior, B, Middle, and C, Posterior 
Lobes of the Cerebrum. 

a. Forepart of the Longitudi- 

nal or Inter-hemispheric 
Fissure 

b. Notch between the Hemi- 

spheres of the Cerebel- 
lum. 

c. Optic Commissure. 

d. Left Crus Cerebri. 

e. Lobus Perforatus Lateralis. 
e to i. Inter-crural Lamina. 

ff. Convolution of the Fissure 
of Sylvius. 

i. Infundibulum. 

I. Right Crus Cerebelli. 
m,m. Hemispheres of the Cerebel- 
lum. 

n. Eminentia Mammillaria 

o. Pons Varolii, forming by its 
continuation on each side 
the Crus Cerebellum. 

p. Pons Tarini. 



£• 


Horizontal Fissure of the 




Cerebellum. 


r. 


Gray Tuber. 


s, s. 


Fissure of Sylvius. 


t. 


Left Crus of the Cerebrum. 


u, u. 


Optic Tracts. 


v. 


Medulla Oblongata. 


X. 


Marginal Convolution of the 




Longitudinal Fissure. 


1. 


Olfactory Nerve. 


2. 


Optic. 


3. 


Motor Oculi. 


4. 


Trochlearis or Patheticus. 


5. 


Trigeminal or Trifacial. 


6. 


Motor Externus. 


7. 


Facial. 


7. 


Auditory. 


8 


. G-losso-pharyngeal. 


8. 


Pneuraogastric. 


8. 


Spinal Accessory. 


9. 


Hypoglossal, 



NERVES. 49 

Substantia Perforata — Perforated space at com- 
mencement of the fissure of Sylvius. 
Next examine the nerves. 

1. The First Pair or Nerves, the Olfactory, arise 
from the outside of the corpora striata, between the an- 
terior and middle lobe of the brain; run under the ante- 
rior lobes, being lodged in two superficial grooves, and 
lying between the pia and dura mater; expand into a 
small oval ganglion, from which several small filaments 
descend through the cribriform plate of the ethmoid 
bone, to ramify on the membrane lining the nose. 

2. The Second Pair, the Optic, arise from the pos- 
terior part of the optic thalami, and also from the tuber- 
cula quadrigemina ; they make a circle round the crura 
cerebri called the Tractus Opticus. The two nerves 
approach gradually, and unite, just before the pituitary 
gland, on the forepart of the sella turcica. They then 
diverge, and each nerve passes out at the foramen opti- 
cum of the sphenoid bone, to form the retina of the eye. 

On each side of these nerves are seen the Carotid 
Arteries. Each artery emerges from the cavernous 
sinus by the side of the anterior clinoid process : sends 
a branch forward, which, uniting with a similar branch 
of the other carotid, forms the anterior part of the ClR- 
culus Arteriosus Willisii ; while other branches, pass- 
ing backward,, and uniting with branches of the basilar 
artery, complete the posterior part of the arterial circle. 

A fold of dura mater passes from the anterior to the 
posterior clinoid process of each side. This fold is dou- 
ble, and forms by its duplicature the Cavernous sinus. 

On dividing the optic nerves, and inverting them, we 
see the infundibulum, a funnel of cineritious substance, 
leading from the inferior and anterior extremity of the 
third ventricle to the pituitary gland ; it is generally im- 
perforate before it reaches the gland. 

The Pituitary- Gland, a reddish body somewhat 
globular, consisting of two lobes, is situated in the sella 
turcica of the sphenoid bone, partly covered by a fold 
of dura mater, and attached to the infundibulum. The 
circular sinus is situated at this point. 



50 PRACTICAL ANATOMY. 

3. The Third Pair of Nerves, Motores Oculorum, 
arise from the crura cerebri, 1 pass outward and forward 
on the outer side of the posterior clinoid process into the 
cavernous sinus, and running through the foramen lace- 
rum orbitale superius of sphenoid bone to the muscles of 
the eye. 

Between these two nerves are seen the two vertebral 
arteries, ascending and uniting, to form the basilary 
artery. 

4. The Fourth Pair, Trochleares or Pathetici, 
are very slender, and situated immediately under the 
edge of the tentorium. This nerve arises from the valve 
of Vieussens, comes out from betwixt the cerebrum and 
cerebellum, passes by the side of the pons Varolii, and 
passing through the cavernous sinus, continues its course 
through the foramen lacerum orbitale superius, to supply 
the obliquus superior muscle of the eye. 

5. The Fifth Pair, Trigemini, are much larger than 
the fourth, and are situated more outward and back- 
ward. Each of these nerves arises by a number of fila- 
ments, from the anterior and lowest part of the crus 
cerebelli, where the crus unites with the pons Varolii; 
it passes forward, enters the cavernous sinus, where it 
untwists itself, and forms a flat irregular ganglion, the 
Ganglion Gasserianum, and then divides into three 
great branches. 

(1) Ramus Ocularis, or the Ophthalmic Nerve of 
Willis, passes through the foramen lacerum orbitale su- 
perius to the appendages of the eye. 

(2) Ramus Maxillaris Superior passes through the 
foramen rotundum to the upper jaw and face. 

(3) Ramus Maxillaris Inferior passes through the 
foramen ovale to the lower jaw and tongue. 

6. The Sixth Pair, Motores Oculorum Externi, 
or abductores. — This nerve is small, but not so small as 



1 The two crura pass obliquely backward and inward, so as to 
converge and meet in front of the tuber annulare ; it is from the hol- 
low formed by their convergence, and named by Vicq d'Azyr, fosse 
des nerfs oculo-musculaires, that the third pair arise. 



NERVES. 51 

the fourth pair; it is seen arising betwixt the pons Va- 
rolii and corpora pyramidalia. It enters the cavernous 
sinus; it there runs by the side of the carotid artery, 
and passes through the foramen lacerum orbitale superius 
to the rectus externus oculi. 

7. The Seventh Pair, Nervi Auditorit, consist 
of two portions. 1 

(1) The Portio Dura, or the facial nerve, arises from 
the crus cerebelli, and comes out from the fossa or 
groove betwixt the pons Varolii, corpora olivaria, and 
crura cerebelli. 

(2) The Portio Mollis, or more properly the auditory 
nerve, arises from the inner surface of the fourth ven- 
tricle. It has a groove on its surface for receiving the 
portio dura ; accompanied by an artery, they enter the 
meatus auditorius internus, where the portio mollis is 
distributed to the parts of the internal ear, while the 
portio dura runs through the aqueduct of Fallopius, and 
comes out at the stylo-mastoid foramen below the ear, to 
form the principal nerve of the face. 

8. The Eighth Pair consists of three, the Par Vagum, 
Spinal Accessory, and Glosso-Pharyngeal. The Par 
Vagum arises by numerous filaments from the sides of 
the corpora olivaria and medulla oblongata. They unite, 
run toward the foramen lacerum in basi cranii, pierce 
the dura mater, and pass out through the anterior part 
of the hole, having been first joined by the 

Nervus Accessorius, which runs up from the med- 
ulla spinalis through the great occipital foramen, and 
then separate to their different destinations. 

The great Lateral Sinus passes out by the back 
part of the same foramen, to form the internal jugular 
vein; it is separated from the nerve by a slip of cartilage. 

9. The Ninth Pair, Linguales or Hypoglossal. — 
This nerve arises from the furrow betwixt the corpora 



1 The classification of Soemmering makes twelve pairs of cranial 
nerves. Thus the Portio Dura and Mollis would be 7th and 8th 
pairs. The Glosso-Pharyngeal the 9th, Pneumogastric the 10th. 
The Spinal Accessory the 11th, and Hypoglossal the 12th. 



52 PRACTICAL ANATOMY. 

olivaria and pyramidalia, by several filaments, which 
often pierce the dura mater separately. It passes 
through the anterior condyloid hole of the occipital bone 
to supply the muscles of the tongue. 

Immediately after leaving the cranium, the eighth 
and ninth pair and the ganglion of the sympathetic are 
connected together. 

Vessels of the Brain. 

Internal carotid enters the skull through the carotid 
foramen in the temporal bone ; passing through the 
cavernous sinus it divides into the following branches : 

1. Anterior Cerebri, passing between the anterior 
cerebral lobes. 

2. Media Cerebri, in the fissure of Sylvius. 

3. Arteria Communicans, passing back to unite 
with the Basilar. 

Vertebral Artery — From the subclavian ascends 
through the foramina of the cervical transverse pro- 
cesses, enters the foramen magnum, and gives branches 
to the dura mater and medulla spinalis, then 

1. Inferior Cerebellar to under part of cerebel- 
lum. The union of the two vertebral form the 

2. Basilar, which rests on the pons Varolii. 

3. Superior Cerebellar to upper part of cerebel- 
lum. 

4. Posterior Cerebral to the posterior lobes of the 
cerebrum. With this usually the communicating branch 
from the carotid unites to form the circle of Willis. 

The veins open into the sinuses, and they into the 
internal jugular vein. 

Medulla Spinalis, or the Spinal Marrow. This 
part of the nervous or sensorial system must be here 
described, although its dissection cannot be performed 
till all the muscles of the back are removed, so that the 
posterior part of the spinal canal may be sawed off. 

The spinal canal is lined by a strong ligamentous 
sheath, and the dura mater is continued down upon this 
sheath in the form of a funnel. 



THE SPINAL MARROW. 



53 



The spinal marrow consists externally of medullary- 
substance, internally of vesicular. It runs down to the 
first lumbar vertebra, where it terminates by numerous 
filaments, which form the Cauda Equina. It is closely 
embraced by the pia mater, while the tunica arachnoides 
adheres to that membrane very loosely. Daring the 
whole of its passage, there is on each side a membranous 
connection between the pia and dura mater, by distinct 
slips, irregular and pointed, which connection is named 
Ligamentum Denticulatum. This ligament separates 
the two roots of the spinal nerves. The arteries of the 
medulla may be seen running down on its anterior and 
posterior surfaces; they are branches of the vertebral 

Fig. 14. 
Fissures or Sulci of the Spinal Marrow. 




1. Anterior Longitudinal Fis- 

sure. 

2. Posterior Longitudinal Fis- 

sure. 

3. Antero-Lateral Fissure, for 

the Corresponding Roots 
of the Spinal Nerves. 

4. Postero - Lateral Fissure, 5 ' 

for the Posterior Koots 
of the Spinal Nerves. 

5. Lateral Fissure. 



artery ; and on these surfaces the Anterior and Pos- 
terior Median or Longitudinal Fissure, dividing it 
into lateral columns. Each column is again divided into 
three others by two lateral lines, the points where the 
roots of the spinal nerves come out. The cord has two 
enlargements upon it, the upper corresponding to the 
origin of the brachial plexus, the lower to the lumbar 
nerves. 

The spinal accessory nerve is seen arising by small 
twigs from the posterior bundles of the fourth, fifth, 
sixth, and seventh cervical nerves ; it then ascends along 
the spinal canal, enters the foramen, and passes forward, 
to accompany the par vagum. 



54 



PRACTICAL ANATOMY. 



The spinal marrow sends off thirty-one pairs of spinal 
nerves, which pass through the foramina formed between 
the bodies of the vertebrae. They consist of eight cer- 
vical, twelve dorsal, five lumbar, and five or six sacral 

Fig. 15. 
Origin of the Spinal Nerves. 



1. Lateral Columns, 
marked off in front 
at (2) the Anterior 
Fissure 

3. Anterior Roots. 

4. Posterior Roots. 

5. Ganglion formed by 
the Posterior Roots. 

6. Spinal Nerve, form- 
ed by the junction of 
the Anterior and 
Posterior Roots. 

7. Anterior Branch of 
the Spinal Nerve. 

8. Posterior Branch. 



pairs of nerves. Each of these nerves arises in two 
fasciculi or roots, one from the forepart, the other from 
the back part of the spinal cord. These fasciculi pene- 
trate the dura mater separately. On the posterior 
bundle or root is a ganglion. 




MUSCLES OF ANTERIOR PART OF NECK. 55 



CHAPTER V. 

DISSECTION OF THE ANTERIOR PART OF THE NECK. 

Of the Muscles. 

The utility of this dissection must be evident, when 
you consider how many important parts are contained in 
the forepart of the neck. The tube which conveys air 
to the lungs, the vessels which are sent from the heart 
to the brain, and the nerves which are destined to supply 
the thoracic and abdominal viscera, are situated in the 
neck; and all these parts lie imbedded in cellular sub- 
stance; hence the dissection is intricate, and requires 
the utmost care in its performance. 

The muscles of the anterior part of the neck are six- 
teen in number on each side. They may be divided into 
muscles situated superficially, muscles at the upper part 
of the neck, and those situated at the lower part. To 
dissect the neck, make one incision from the top of the 
sternum to the symphysis of the chin, a second along 
the base of the jaw to the mastoid portion of the tem- 
poral bone, and a third from the sternum along the 
clavicle to the acromion process of the scapula. Reflect 
the integuments. 

The superficial muscles are two. 

Immediately under the integuments, and adhering to 
them. 

1. The Musculus Cutaneus, vulgo, Platysma my- 
oides — Will be found to be between two layers of the 
superficial fascia of the neck; the fascia extends over 
face and parotid gland. It arises, by slender separate 
fleshy fibres, from the cellular substance, covering the 
upper part of the deltoid and pectoral muscles. These 
fibres form a thin broad muscle, which runs obliquely 
upward, and is 



56 PRACTICAL ANATOMY. 

Inserted into the skin and muscles covering the lower 
jaw and cheek. This muscle should be dissected in the 
course of its fibres; the skin, therefore, must be dis- 
sected off in an oblique direction from the clavicle to 
the chin. 

Use. To draw the skin of the cheek downward, and, 
when the mouth is shut, to draw the skin under the 
lower jaw upward. 

Remove the platysma myoides from its origin, and in- 
vert it over the face. Immediately beneath it is seen 
the external jugular vein, which is formed of branches 
from the temple, side of the face, and throat. It crosses 
obliquely over the sterno-mastoideus, passes behind the 
outer edge of that muscle, and plunges beneath the cla- 
vicle, to enter the subclavian vein. 

If the platysma has been carefully lifted, several 
nerves may be exhibited in its deep surface. One to- 
ward the angle of the jaw. 

Superficialis Colli — One to the ear just behind 
the jugular vein, the Auricularis Magnus; one along 
the posterior border of the S. cleido-mastoid muscle to 
the back of the head, the Occipitalis Minor ; other 
branches descend ; some of which are deep for the sup- 
ply of muscles. All these are from the Superficial 
Cervical Plexus, which comes out just behind the 
middle of the sterno-cleido-mastoid muscle, and is formed 
by the anterior branches of the three or four upper 
spinal nerves. 

The strong fascia seen covering the muscles of the 
neck after the removal of the Platysma. It forms 
sheaths for the muscles of the neck by detaching from 
its deep surface septa which pass in between them. It 
is attached behind to the spinous processes of the cervi- 
cal vertebrae under the trapezius muscle ; above to the 
base of the jaw as it passes to the face, and at its angle 
dips down to the styloid process, forming the Stylo- 
Maxillary Ligament, and forming, as will be seen 
again, a complete separation between the Parotid and 
Submaxillary Glands. Along the middle line of the 
neck it meets the fascia of the opposite side, incasing 



MUSCLES OF ANTERIOR PART OF NECK. 



57 



muscles and thyroid gland; below it is attached both 
to the top and inner surface of the sternum, to the 
sternal end of the clavicle, to the cartilage of the first 
rib, and is connected to the sheaths of the bloodvessels 
and nerves as they pass into the axilla. 

Fig. 16. 




1. Platysma Myoides Muscle. 

2. Scattered Fibres of the same, forming the Musculus Risorius of 

Santorini. 

3. Sterno-Cleido-Mastoid Muscle. 

4. Trapezius. 

5. Splenius. 

6. Posterior Large Triangle of the Neck, bounded in front by the 

Sterno-Cleido-Mastoid, behind by the Trapezius, and below by 
the Clavicle. 



2. The Sterno-Cleido-Mastoideus — Arises by two 
distinct origins ; the anterior, tendinous and fleshy, and 
somewhat round, from the top of the sternum, near its 
junction with the clavicle ; the posterior or outer, fleshy 
and flat, from the upper and anterior part of the clavi- 
cle. These two origins soon unite, and form a strong 

4 



58 PKACTICAL ANATOMY. 

muscle, which ascends obliquely upward and outward, 
to be 

Inserted, tendinous, into the outside of the mastoid 
process, and into the transverse ridge behind that pro- 
cess. 

Use. When one acts singly, it turns the head to one 
side. When both act together, they bend the head for- 
ward. 

The muscle should be detached from the sternum and 
clavicle, and left suspended by its insertion. It is pierced 
by several branches of the cervical nerves, and, about 
its middle, it is perforated by the Nervus Accessorius. 
These nerves ramify on the neighboring muscles of the 
neck and shoulder. Between the posterior edge of the 
sterno-cleido-mastoideus and the forepart of the trapezius 
muscles, above the clavicle, is seen a quantity of loose 
fatty substance, intermixed with branches of nerves. 
This fatty substance is watery and granulated ; it must 
not be removed roughly, lest important nerves and ves- 
sels be injured; it is continued around the vessels under 
the clavicle. 

In the middle of the throat you see 

(1) The Os Hyoides, or bone of the tongue, forming 
the uppermost of the projections beneath the chin. 

(2) The Larynx, or upper part of the trachea, con- 
sisting of five cartilages, of which two are evident ex- 
ternally, viz.: 1. The uppermost and largest is the 
thyroid cartilage ; 2. The inferior is the cricoid cartilage. 
The two arytenoid cartilages, and the epiglottis, lie be- 
hind this. 

(3) The Trachea, consisting of cartilaginous rings, 
and extending into the thorax. 

(4) Behind the larynx* is situated the pharynx. At 
the part where the larynx terminates in the trachea, the 
pharynx contracts itself, and forms the oesophagus, or 
muscular tube, conveying the food to the stomach, which 
descends behind the trachea, situated rather to the left 
side of the cervical vertebrae. 

These parts are covered by muscles, and on each side 
of the trachea lie the great vessels and nerves. 



MUSCLES OF ANTERIOR PART OF NECK. 59 

Muscles at the lower part of the neck are five. 

8. The Sterno-Hyoideus — Arises, thin and fleshy, 
from the upper and inner part of the sternum, clavicle, 
and first rib ; it forms a flat and narrow muscle. 

Inserted into the base of the os hyoides. 

Situation. This pair of muscles is seen on removing 
the platysma myoides, between the sterno-cleido-mas- 
toidei. 

Use. To pull the os hyoides downward. 

4. The Omo-Hyoideus, inclosed in lamina of the deep 
fascia — Arises, broad, thin, and fleshy, from the root of 
the coracoid process, and semilunar notch of the scapula, 
ascends across the neck, and forms a middle tendon, 
where it passes below the sterno-cleido-mastoideus. Be- 
coming fleshing again, it runs up, and is 

Inserted into the base of the os hyoides, between its 
cornu and the insertion of the sterno-hyoideus. 

Situation. The lower part of this muscle is covered 
by the trapezius; its middle by the sterno-cleido-mas- 
toideus; its anterior part is seen on removing the pla- 
tysma myoides ; it crosses over the carotid artery and 
internal jugular vein. 

Use. To pull the os hyoides obliquely downward. 

5. The Sterno-Thyroideus. — This muscle arises, 
fleshy, from the inside of the sternum, and of the ex- 
tremity of the first rib ; forms a flat muscle, and is 

Inserted into the inferior edge of the oblique ridge on 
the ala or side of the thyroid cartilage. 

Situation. Beneath the sterno-hyoideus. 

Use. To draw the thyroid cartilage, and consequently 
the larynx, downward. 

Under the sterno-thyroideus we find situated the 

Thyroid G-land, a large reddish mass, situated on the 
superior rings of the trachea, below the cricoid cartilage ; 
in form somewhat like a crescent, with the cornua turned 
upward. 

6. The Thyro-Hyoideus — Arises, fleshy, from the 
upper surface of the oblique ridge in the ala of the thy- 
roid cartilage, and passes upward, to be 

Inserted into part of the base, and almost all the cornu 
of the os hyoides. 



60 PRACTICAL ANATOMY. 

Use. To pull the os hyoides downward, or the thy- 
roid cartilage upward. 

Situation. Concealed by the sterno-hyoideus. 

7. The Crico-Thyroldeus — Arises, tendinous and 
fleshy, from the side and forepart of the cricoid carti- 
lage, and runs obliquely upward. 

Inserted, by two fleshy portions, the first into the 
lower part of the thyroid cartilage, and the second into 
its inferior cornu. 

Situation. On the side of the larynx, and under the 
sterno-thyroideus. 

Use. To pull forward and depress the thyroid, or to 
elevate and draw backward the cricoid cartilage. 

The muscles at the upper part of the neck consist of 
nine pairs. 

8. The Digastricus — Arises, principally fleshy, from 
the fossa at the root of the mastoid process of the tem- 
poral bone ; its fleshy belly terminates in a strong round 
tendon, which runs downward and forward, passes 
through the fleshy belly of the stylo-hyoideus, is fixed 
by strong ligamentous and tendinous fibres to the os 
hyoideus, from which it receives an addition of fibres ; it 
then becomes again fleshy, and runs obliquely upward, 
to be 

Inserted into a rough sinuosity on the anterior infe- 
rior edge of that part of the lower jaw called the Chin. 

Situation. Its posterior belly is covered by the sterno- 
cleido-mastoideus ; its anterior belly lies immediately 
under the skin and platysma myoides. 

Use. To open the mouth, by pulling the lower jaw 
downward and backward; and, when the jaws are shut, 
to raise the larynx, and consequently the pharynx up- 
ward, as in deglutition. 

In the triangular space formed by the two bellies of 
this muscle, and the base of the lower jaw, lies the Sub- 
maxillary Gland. It lies upon a flat muscle, the mylo- 
hyoideus, which is seen between the two bellies of the 
digastricus ; the gland is surrounded by little absorbent 
glands, and is incased in a pocket of deep fascia. 

9. The Stylo-Hyoideus — Arises, tendinous, from 



MUSCLES OF ANTERIOR PART OF NECK. 



61 



Fig. 17. 




Lateral View of the Neck, with the Skin, Platysma, and Cer- 
vical Fascia removed. 



«, a. 
b. 



Sternal ends of the Clavicles. 

Upper part of the Sternum. 

Third portion of the Subcla- 
vian Artery. 

Primitive Carotid Artery di- 
viding into the internal and 
external Carotids. 

Posterior Scapular Artery. 

Transverse Cervical or Su- 
pra-scapular Artery. 

Brachial Plexus of Nerves. 

Trapezius Muscle. 

Tendon of the Omo-hyoid 
Muscle. 



k. Anterior belly of the Omo- 
hyoid. 

I. Sterno-Cleido-Mastoid Mus- 
cle. 
m, m, Sterno-hyoid Muscles. 

n. Larynx. 

o. Parotid Gland. 

p. Submaxillary Gland. 

q. Posterior Belly of the Di- 
gastric Muscle. 

r. Anterior Belly of the same. 

s. Stylo-hyoid Muscle. 

t. Hyoid Bone. 



the middle and inferior part of the styloid process of 
the temporal bone ; its fleshy belly is generally perfo- 
rated by the digastricus. 



62 PRACTICAL ANATOMY. 

Inserted, tendinous, into the os hyoideus at the junc- 
ture of its base and cornu. 

Situation. The origin of this muscle is situated more 
inward than the last ; it is the most superficial of three 
muscles which arise from the styloid process; sometimes 
it is accompanied by another small muscle, having the 
same origin and insertion, the stylo-hyoides alter. 

Use. To pull the os hyoides to one side, and a little 
upward. 

10. The Stylo-Glossus — Arises, tendinous and fleshy, 
from the styloid process, and from a ligament that con- 
nects that process to the angle of the lower jaw. It de- 
scends, and becomes broader, but less thick. 

Inserted into the root of the tongue, runs along its 
side, and is insensibly lost near its tip. 

Situation. This muscle lies within and rather above 
the stylo-hyoideus ; underneath it is a ligament, extend- 
ing from the styloid process to the angle of the os hy- 
oides. Ligamentous fibres are also seen passing from 
that process to the inside of the angle of the lower jaw, 
Stylo-Maxillary Ligament. 

Use. To move the tongue laterally and backward. 

11. The Stylo-Pharyngeus — Arises, fleshy, from the 
root and inner part of the styloid process. 

Inserted into the side of the pharynx and back part 
of the thyroid cartilage. 

Situation. It is situated deeper, and behind the stylo- 
glossus. 

Use. To dilate and raise the pharynx and thyroid 
cartilage upward. 

On removing the submaxillary glands, and detaching 
the digastric muscle from the os hyoides and chin, we 
expose the next muscle ; but should notice in its removal 
the facial artery which runs through it on its way to the 
face, giving to it the Submaxillary Branches, and 
one which runs along the jaw toward the chin, the Sub- 
mental. 

12. The Mylo-Hyoideus — Arises, fleshy, from all the 
inside of the lower jaw, between the last molar tooth 
and the middle of the chin; the fibres form a flat muscle, 
converge, and are 



MUSCLES OF THE TONGUE. 63 

Inserted into the lower edge of the base of the os hy- 
oides. 

Situation. This muscle unites with its fellow in a mid- 
dle tendinous line which extends from the os hyoides to 
the chin ; its posterior part is lined by the internal mem- 
brane of the mouth; it lies under the digastricus, but is 
seen betwixt its bellies. 

Use. To pull the os hyoides forward, upward, and to 
either side. 

The submaxillary gland sends off a duct, which passes 
behind the posterior edge of the mylo-hyoideus, and runs 
along the inner surface of this muscle forward and up- 
ward, on the inside of the sublingual gland, to open into 
the mouth on the side of the frenum of the tongue. 
Above it will be seen the Lingual Branch of the infe- 
rior maxillary nerve. 

The Sublingual Gland lies immediately above the 
mylo-hyoideus, betwixt it and the internal membrane of 
the mouth, where it lines the side and inferior surface of 
the tongue. It sends off several ducts, which open into 
the mouth, between the root of the tongue and side of 
the lower jaw. 

The removal of the mylo-hyoideus exposes a pair of 
muscles, which are closely attached to one another. 

13. The Genio-Hyoideus — Arises, tendinous, from 
a projection on the inside of that part of the lower jaw 
which is called the Chin; it descends, becoming broader, 
and is 

Inserted into the basis of the os hyoides. 

Use. To draw the os hyoides forward and upward to 
the chin. 

By removing this muscle, or turning it back from its 
origin from the jaw, we discover the next muscle. 

14. The Genio-Hyo-Glossus — Arises, tendinous, 
from a rough protuberance on the inside of the lower 
jaw, higher up than the origin of the genio-hyoideus ; 
its fibres run forward, upward, and backward, in a very 
wide and radiated manner, to be 

Inserted, some into the posterior part of the base of 
the os hyoides, near its cornu, others into the tip, mid- 
dle, and root of the tongue. 



64 



PRACTICAL ANATOMY. 



Situation. This muscle lies under the genio-hyoideus 
before, and more outwardly under the mylo-hyoideus. 

Fig. 18. 




Muscles of the Tongue. 



1. 


Stylo-glossus. 


7. 


Genio-hyo-glossus. 


2. 


Stylo-hyoideus. 


8. 


Stylo-pharyngeus. 


3. 


Lingualis. 


9. 


Genio-hyoideus. 


4. 


Dorsum of the Tongue. 


10. 


Raphe of the Mylo-hyoideus 


5, 6. 


Hyo-glossus. 


11. 


Digastricus. 



Use. According to the direction of its fibres, to draw 
the tip of the tongue backward into the mouth, the mid- 
dle downward, and to render its dorsum concave; to 
draw its root and the os hyoides forward, and to thrust 
the tongue out of the mouth. 

15. The Hyo-Glossus — Arises, broad and fleshy, 
from half of the base, and part of the cornu of the os 
hyoides ; the fibres run upward, to be 

Inserted into the inside of the tongue. Be careful 
here of the Hypoglossal Nerve, and Lingual Artery, to 
be presently described. 

Situation. It is situated more outwardly than the 



ARTERIES SEEN IN DISSECTION OF NECK. 65 

genio-hyo-glossus, and, at its insertion into the tongue, 
mixes with the stylo-glossus. 

Use. To move the tongue inward and downward. 

16. The Lingualis — Arises, from the root of the 
tongue laterally, and runs forward between the hyo- 
glossus and genio-hyo-glossus, to be 

Inserted into the tip of the tongue, along with part of 
the stylo-glossus. 

Use. To contract the substance of the tongue, and 
bring it backward. 

Of the Vessels and Nerves seen in the Dissection of the 

Neck. 

Arteries. 

The Carotid Artery ascends from the thorax by 
the side of the trachea; on its outer side it has the in- 
ternal jugular vein and the par vagum, and behind the 
sympathetic nerves. All these parts are connected and 
inclosed by condensed cellular membrane, which forms 
a kind of sheath for containing them. At the bottom, 
and in the middle of the neck, the carotid is covered by 
the sterno-cleido-mastoideus ; at the upper part, by adi- 
pose membrane, absorbent glands, and by the platysma 
myoides. It lies deep on the muscles of the spine, and 
gives off no branches, until it reaches the space between 
the larynx and angle of the jaw, just below the cornu 
of the os hyoides, where it divides into the external and 
internal carotids. 

Of the two, the internal carotid is situated most out- 
wardly ; it passes deep to the base of the cranium, where 
it enters the foramen caroticum, to supply the brain. 

The external carotid immediately begins to send oft' 
branches. 

Anteriorly it sends off 

1. The A. Thyroidea Superior. — This artery passes 

downward and forward, to ramify on the thyroid gland, 

where it inosculates with the artery of the other side, 

and with the inferior thyroid arteries. In this course, it 

4* 



66 PRACTICAL ANATOMY. 

sends ramifications to the integuments, the outside of the 
larynx, the muscles, etc., and one remarkable branch, 
the A. Laryngea, which sometimes arises from the trunk 
of the external carotid ; it is a small artery which di- 
vides betwixt the os hyoides and thyroides cartilages, to 
supply the internal parts of the larynx. 

2. A. Lingualis. — This artery passes over the cornu 
of the os hyoides, then parallel with it, covered by the 
stylo-glossus, hyo-glossus, and genio-hyo-glossus, to 
which it gives branches, and terminates in running 
along the inferior part of the tongue from its base to 
its apex. It gives branches to the muscles about the 
chin, and to the substance and back part of the tongue. 

3. A. Facialis. — The external maxillary artery 
passes under the stylo hyoideus and posterior belly of 
the digastricus, then buries itself under the submaxil- 
lary gland. It runs over the lower jaw before the an- 
terior edge of the masseter muscle, to supply the face. 

In its passage, it gives off numerous branches. One 
is worthy of notice, which runs along under the line of 
the lower jaw, 

The Submental, and passing over the jaw near the 
symphysis, supplies the chin. Other twigs supply the 
submaxillary gland, etc. 

Posteriorly the carotid sends off 

4. A. Occipitalis. — The occipital artery crosses 
backward and upward, over the internal jugular vein 
and internal carotid artery, under the belly of the di- 
gastric muscle; it passes through a slight groove in the 
mastoid process, below its great fossa, and ramifies on 
the back part of the head. A remarkable branch of the 
occipital passes toward the base of the skull, to inoscu- 
late near the foramen magnum occipitis, with branches 
from the vertebral and posterior cervical arteries. 

5. A. Pharyngea is a small branch of the carotid, 
which passes inward to the pharynx and base of the 
skull. 

6. Posterior Auris, which passes backward and 
upward in the fold, between the ear and scalp, and is 
distributed on the integuments of the head. 



NERVES SEEN IN DISSECTION OF NECK. 67 

The external carotid ascends behind the angle of the 
jaw, and enters the parotid gland, where it divides into 

7. A. Maxillaris Interna. 

8. A. Temporalis. 

9. A. Transversalis Faciei. 

These arteries are described in the dissection of the 
face. 

Veins. 

The Internal Jugular Vein is a continuation of 
the lateral sinus which passes through the foramen lace- 
rum in the base of the cranium. It comes out deep 
from under the angle of the jaw, and in its course down 
the neck, it runs on the outer side of the carotid artery, 
before it reaches the thorax; it passes rather more for- 
ward than the artery, to join the subclavian vein. 

Its branches accompany the ramifications of the ex- 
ternal carotid. At first the vein which accompanies 
each artery is a single branch, but it soon subdivides, 
so that two veins accompany one artery. 

Nerves. 

1. The Eighth Pair, or Par Vagum.— On separating 
the internal jugular vein, and trunk of the carotid artery, 
the par vagum is seen lying in the same sheath of cellu- 
lar substance with those vessels. It lies in the triangular 
space formed betwixt the back part of the artery and 
vein, and the subjacent muscles. This nerve comes out 
of the foramen lacerum with the jugular vein; hence it 
adheres to that vein more closely than to the artery or 
muscles; it runs down the neck behind these vessels. 

In this course it gives off several nerves.. 

(1) At the base of the cranium it sends off several 
filaments, which are connected with the other nerves 
coming out of the base of the skull, such as the ninth 
pair, the superior cervical ganglion of the sympathetic, 
etc. 

(2) Nervus G-losso-Pharyngeus leaves the other 
branches of the eighth pair, deep under the angle of the 



68 



PRACTICAL ANATOMY. 



jaw. It passes behind the carotids toward the muscles 
arising from the styloid process; one principal branch of 
it passes between the stylo-pharyngeus and stylo-glossus 
to the tongue, while other twigs run behind the stylo- 
pharyngeus, to supply the pharynx. 

Fig. 19. 
Nerves op the Neck and Tongue. 

1. Part of the Temporal Bone. 

2. Stylo-hyoid Muscle. 

3. Stylo-glossus Muscle. 

4. Stylo-pharyngeus Muscle. 

5. Tongue. 

6. Hyo-glossus Muscle. 

7. Genio-hyo-glossus Muscle. 
9. Sterno-hyoid Muscle. 

10. Sterno-thyroid Muscle. 

11. Thyro-hyoid Muscle, upon 
which is seen a branch of 
the Hypoglossal Nerve. 

12. Oroo-hyoid Muscle straight- 
ened by the removal of 
the Loop of Cervical Fas- 
cia through which its 
tendon plays. 

13. Common Carotid Artery. 

14. Interna] Jugular Vein. 

15. External Carotid Artery. 

16. Internal Carotid. 

17. Gustatory Branch of the 
Fifth Nerve, giving a 
Branch to (18) the sub- 
maxillary Ganglion. 

19. Duct of Submaxillary Gland. 

20. Glosso-pharyngeal Nerve. 

21. Hypoglossal Nerve. 

22. Descending Branch from the Cervical Plexus. 

23. Communicating Branch from the Cervical Plexus. 

24. Pneumogastric Nerve emerging from between the Internal Jug- 

ular Vein and Common Carotid Artery to enter the Chest. 

25. Facial Nerve, emerging from the Stylo mastoid Foramen, and 

crossing the External Carotid Artery. 

(3) Nervus Laryngeus Superior. — The superior or 
internal laryngeal nerve passes behind the internal caro- 
tid artery, obliquely, downward and forward; then, under 
the hyo-thyroideus muscle, it plunges betwixt the os 
hyoides and thyroid cartilage, accompanying the laryn- 




NERVES SEEN IN DISSECTION OF NECK. 69 

geal artery, and supplying the internal parts of the 
larynx. 

(4) In the neck, also, the par vagum gives off fila- 
ments to the cervical ganglions of the sympathetic nerve, 
and communicates with the other nerves of the neck. 
Filaments also unite with twigs of the sympathetic, and 
run down over the carotid artery to the great vessels of 
the heart, where they form the superior cardiac plexus. 

The par vagum enters the thorax by passing betwixt 
the subclavian artery and vein. 

2. The Great Sympathetic Nerve. — This nerve 
lies behind the carotid, in the cellular membrane, be- 
twixt that vessel and the muscles covering the vertebrae 
of the neck. It is distinguished from the par vagum by 
being smaller, lying nearer the trachea, and adhering to 
the muscles of the spine ; also by its forming several 
ganglions. It comes out by the same foramen as the 
carotid artery. 

Immediately after its exit from the skull, it forms the 
Superior Cervical Ganglion, which is very long, and 
of a reddish color. The nerve afterward becomes smaller, 
and descends; and opposite the fifth or sixth cervical 
vertebra, it forms another swelling, the Inferior Cer- 
vical Ganglion. Sometimes it has another ganglion 
about the fourth or fifth vertebra of the neck, the Mid- 
dle Cervical Ganglion: but this is not a constant 
appearance. The nerve then passes behind the subcla- 
vian artery into the thorax. 

The branches of the intercostal nerve are numerous, 
and they generally pass off from the ganglions. Imme- 
diately below the base of the cranium, twigs go to the 
eighth and ninth pairs, and to the upper cervical nerves. 
In the middle of the neck, some twigs pass over the 
carotid ; others go to the parts covering the trachea, 
uniting with filaments of the par vagum; others unite 
with the descendens noni, or descending branch of the 
ninth pair, and some filaments assist the twigs of the par 
vagum to form the superior cardiac nerve. In the lower 
part of the neck, twigs are sent to communicate with the 
cervical nerves, etc. 



70 



PRACTICAL ANATOMY. 

Fig. 20. 




Cervical and Brachial Plexuses of Nerves of the Right Side. 

1. Facial Nerve. 

2. Pneumogastric Nerve. 
8. Internal Carotid Artery. 

4. Spinal Accessory Nerve. 

5. Anastomoses of the Spinal Accessory Nerve with the Cer- 

vical Plexus. 

6. Hypoglossal Nerve, giving off its Descending Branch. 



NERVES SEEN IN DISSECTION OF NECK. 71 

7. Anterior Branch of the first Cervical Nerve, anasto- 

mosing with the Hypoglossal Nerve and with the Pneu- 
mogastric. 

8. Descending Cervical Branch of the Cervical Plexus, 

anastomosing with the corresponding Branch of the 
Hypoglossal. 

9. Phrenic Nerve. 

10, 10. Deep Cervical Branches of the Cervical Plexus. 

11. Brachial Plexus. 

12. Branch to the Subclavian Muscle, sending a Filament to 

the Phrenic Nerve. 

13. Anterior Thoracic Branches. 

14. Lateral Thoracic Branch, or the Branch to the Great 

Serrate Muscle. 
15, 16, 17. Subscapular Branches going to the Subscapular, Latissi- 
mus, and Greater Teres Muscles. 

18. Axillary Artery, surrounded by a sort of Sheath, formed 

by Branches going to the Arm. 

19. Brachial Branches. 

3. The Ninth Pair, Nervus Hypoglossal, or Lingual 
Nerve, having left the skull by the anterior condyloid 
foramen, is connected with the eighth pair and sympa- 
thetic nerve. Like them, it lies deep, and comes out 
from under the angle of the jaw. It is seen passing 
from behind the internal jugular vein, and then over the 
carotid artery, running betwixt these two vessels. It next 
passes under the mylo-hyoideus, running over the stylo- 
glossus, hyo-glossus, and genio-hyo-glossus, which last 
muscle its numerous branches perforate. 

4. Branches. — While the nerve is passing betwixt 
the jugular vein and the carotid artery, it sends off the 
Descbndens Noni. — This small and delicate nerve de- 
scends on the forepart of the vein and artery, and is 
distributed to the muscles on the anterior part of the 
trachea. It is joined by a filament formed by the first, sec- 
ond, and third cervical nerves, the Oommunicans Noni. 

The Lingual Branch sent off by the third branch of 
the fifth pair of nerves, is also seen in the dissection of 
the neck. It is found under the mylo-hyoideus; it lies 
close upon the lower edge of the jaw-bone, betwixt the 
inferior edge of the pterygoideus internus and the upper 
part of the mylo-hyoideus. It gives numerous twigs to 
the sublingual gland and submaxillary duct, which are 
situated near it, and is lost in the substance of the tongue. 



72 PRACTICAL ANATOMY. 

5. Nervus Accessorius ad par Vagum, one of the 
eighth pair. — The accessory nerve, having passed out of 
the cranium with the par vagum, separates from it, 
passes behind the internal jugular vein obliquely down- 
ward and backward; it perforates the mastoid muscle, 
and is distributed to the trapezius and muscles about the 
shoulder; it is much connected with the third and fourth 
cervical nerves. 

6. The Seven Cervical Nerves come out from the 
foramina betwixt the vertebrae of the neck. They send 
numerous branches to the muscles, etc. on the side of 
the neck, and communicate by filaments with all the 
other nerves in the neck. 

In this stage of the dissection we may also see 

7. The Phrenic Nerve, formed by branches of the 
third and fourth cervical nerves. This small nerve lies 
upon the belly of the Scalenus Anticus Muscle, and 
passes into the thorax, betwixt the subclavian artery 
and vein. 

8. Recurrent Nerve. — From the par vagum in the 
thorax, lying close alongside the trachea as it ascends. 

9. Brachial Plexus. — Seen between the Scaleni 
Muscles, formed by four lower cervical, and first dorsal 
spinal nerves, passes into the axilla to become the axil- 
lary plexus. 

Arteries. 

Subclavian Artery on the right side is a branch of 
the Innominata, on the left it is derived from the 
Aorta ; on the right side it passes by a gentle curve to 
the scalenus anticus muscle, and rests upon the pleura. 
This first part on the left side rises almost perpendicu- 
larly up out of the chest, and has the pleura in front. 
Both after this pass beneath the scalenus anticus, hav- 
ing the brachial plexus of nerves and the scalenus pos- 
ticus to the outer and posterior side, thence over the 
first rib, after which they become Axillary Arteries. 
Thyroid Axis — A stem which generally furnishes 
1. Inferior Thyroid Artery, which passes under 
the carotid bloodvessels to the thyroid gland. 



ARTERIES OF THE NECK. 
Fig. 21. 



73 






Arteries 


OF TE 


1. 


Heart. 


8. 


2. 



4. 
5. 


Left Coronary Artery. 
Right Coronary Artery. 
Pulmonary Artery cut 

through. 
Arch of the Aorta. 


9. 
10. 


6. 

7. 


Innominata Artery. 
Right Primitive Carotid. 





e Neck. 

Left Subclavian. 

Division of the Innominata 
into the Right Primitive 
Carotid and Right Subcla- 
vian. 

Division of the Primitive Ca- 
rotid into External and In- 
ternal Carotid. 



74 PRACTICAL ANATOMY. 

11. Superior Thyroid Artery. 27. Point at which the Vertebral 

12. Lingual Artery. Artery enters the opening 

13. Facial or External Maxillary in the Transverse Process 

Artery. of the Sixth Cervical Ver- 

14. Inferior Palatine Artery. tebra. 

15. Submental Artery. 28. Left Superior Intercostal Ar- 

16. Inferior Labial Artery. tery. 

17. Superior Labial Artery. 29. Transverse Cervical Artery. 

18. Lateral Nasal Branch, 30. Posterior Scapular Artery. 

19. Occipital Artery. 31. Internal Mammary Artery. 

20. Posterior Auricular Artery. 32. Mediastinal Branch. 

21. Ascending Pharyngeal Ar- 33. Superior Phrenic Artery. 

tery. 34, 35. Anterior Temporal Artery. 

22. Division of the External Ca- 36. Posterior Temporal. 

rotid into Temporal and 37. Trachea. 

Internal Maxillary Artery. 38. Middle Thyroid Artery, an 

23. Transverse Facial Artery. anomalous branch of the 

24. Temporal Artery. aorta sometimes met with. 

25. Middle or Deep Temporal 39 Thyroid Body. 

Artery. 40. Ascending Cervical Artery, 

25. Inferior Thyroid Artery. a branch of the Inferior 

26. Vertebral Artery. Thyroid. 

2. Superficialis Cervicis — distributed to the deep 
layer of muscles front of spine. 

3. Supra-Scapular — following the course of the 
clavicle, it supplies the muscles on the dorsum of the 
scapula. 

4. Posterior Scapular — across the neck, along the 
posterior border of the scapula — supplies the muscles on 
that portion of the scapula. 

Profunda Cervicis — passes back between the trans- 
verse processes of last cervical and first dorsal vertebrae, 
it sends a branch up to inosculate with the Princeps 
Cervicis from the Occipital Artery. 

Backward, the subclavian sends off 

The Vertebral Artery. — This artery arises from 
the back part of the subclavian, passes outward, and 
enters the foramen in the transverse process of the sixth 
cervical vertebra, and ascends through the tranverse 
processes of the vertebrae, to enter the foramen magnum 
of the occipital bone. 

Anteriorly, the subclavian artery gives off 

5. A Mammaria Interna. — The internal mammary 
arises from the forepart of the subclavian opposite the 



COURSE OF BRACHIAL PLEXUS OF NERVES. 75 

cartilage of the first rib ; it runs down on the inside of 
the cartilages of the ribs, and terminates in the abdom- 
inal muscle, where it inosculates with the epigastric. It 
is a large artery, and its branches are very numerous. 
They pass to the external muscles of the chest, to the 
intercostal muscles, pleura, etc. It also sends off the 
Arteria Phrenica Superior, vel comes nervi phrenici, 
which, with two veins, accompanies the phrenic nerve to 
the diaphragm. 

6. The subclavian artery gives twigs to the root of the 
neck, and to the muscles about the scapula. 

7. A. Intercostalis Superior. — Frequently a trunk 
comes off from the subclavian, especially on the right 
side, which passes downward and backward, and lodges 
itself by the spine, to supply the two or three superior 
intercostal spaces. 

Course of the Subclavian Vein. 

The Subclavian Vein is situated anteriorly to the 
subclavian artery ; it passes inward behind and under the 
subclavius muscle, and before and over the belly of the 
anterior scalenus (so that this last muscle lies betwixt the 
vein and artery). It runs over the first rib, where it is 
found in contact with the axillary artery, and is called 
the Axillary Vein. 

The branches of this vein accompany and correspond 
to the ramifications of the subclavian artery, returning 
the blood from the thyroid gland, neck, chest, inter- 
costal spaces, etc. The subclavian vein also receives 
the internal jugular, which passes down behind the 
clavicle. 

The Course of the Brachial Plexus of Nerves 

May also be examined. This plexus is formed by 
branches of the four lower cervical and first dorsal 
nerves, which pass between the anterior and middle 
scaleni muscles into the axilla. In this passage they 
are situated higher up than the artery. 



76 PRACTICAL ANATOMY. 

A considerable part of the scaleni muscles may now 
be seen, covered by a strong fascia, the Prevertebral 
Fascia ; the upper insertion of these muscles must be 
dissected with the muscles of the back part of the neck. 

1. The Scalenus Anticus — Arises, by three ten- 
dons, from the transverse processes of the fourth, fifth, 
and sixth vertebrae of the neck. 

Inserted, tendinous and fleshy, into the upper edge 
of the first rib, near its cartilage. 

2. The Scalenus Medius — Arises, tendinous, from 
the transverse processes of all the vertebrae of the neck. 

Inserted into the upper and outer part of the first rib, 
from its root to within the distance of half an inch from 
the scalenus anticus. 

3. The Scalenus Posticus — Arises, tendinous, from 
the transverse processes of the first and sixth vertebrae 
of the neck. 

Inserted into the upper edge of the first rib, near the 
spine. 

Situation. These muscles are covered before by the 
sterno-mastoideus and trapezius, behind by the trapezius 
and levator scapulae ; but the scaleni are so connected 
with the muscles of the spine that the whole of them 
cannot be demonstrated till the muscles of the back and 
neck are dissected. 

Uses of these three muscles: to bend the neck to 
one side, and, when the muscles of both sides act, to 
bend it forward; or, when the neck is fixed, to elevate 
the ribs, and dilate the chest. 

Dissection of the Muscles on the front of the Cervical 
Vertebrae. 

These muscles may be exposed by raising off the mus- 
cles already dissected, together with the trachea, larynx, 
and oesophagus. There are four pairs. 

1. Longus Colli — Arises, tendinous and fleshy, from 
the sides of the bodies of the three cervical vertebrae, 
and from the anterior surface of the transverse processes 
of the four or five lower cervical vertebrae. 



CERVICAL MUSCLES. 



77 



Inserted, tendinous and fleshy, into the forepart of 
the bodies of all the vertebrae of the neck. 

Situation. This muscle lies behind the oesophagus 
and great vessels and nerves of the neck. 

Use. To bend the neck forward and to one side. 

Fig. 22. 




Cervical Muscles. 



1. 


Basilar Process of the Oc- 


10. 


First Rib. 




cipital Bone. 


11. 


Passage of the Subclavian 


2. 


Mastoid Process. 




Artery 


3. 


Rectus Capitis Anticus Ma- 


12. 


Second Rib. 




jor. 


13. 


Third Dorsal Vertebra. 


4. 


Rectus Capitis Anticus Mi- 


14. 


Transverse Process of the 




nor. 




Atlas. 


5. 


Rectus Capitis Lateralis. 


15. 


First Inte r-transversalis 


6. 


Longus Colli, right side. 




Muscle. 


7. 


Same, left side. 


16. 


Sixth Inte r-transversalis 


8, 8. 


Scalenus Posticus. 




Muscle. 


9. 


Scalenus Anticus. 







2. Rectus Capitis Anticus Major — Arises, tendin- 
ous and fleshy, from the anterior points of the trans- 



78 PRACTICAL ANATOMY. 

verse processes of the third, fourth, fifth, and sixth 
cervical vertebrae. 

Inserted into the cuneiform process of the os occipitis 
in front of the condyloid process. 

Situation. Farther out than the longus colli. 

Use. To bend the head forward. 

3. Rectus Capitis Anticus Minor — Arises, fleshy, 
from the forepart of the body of the first vertebra of 
the neck, close to the transverse process, and ascending 
obliquely, is 

Inserted near the root of the condyloid process of 
the occipital bone, under the last muscle: acts as the 
last. 

4. Rectus Capitis Lateralis — Arises, fleshy, from 
the upper part of the transverse process of the atlas. 

Inserted, tendinous and fleshy, into the transverse 
ridge of the os occipitis. 

Situation. It is immediately behind the internal jugu- 
lar vein, where it comes out from the cranium. 

Use. Draws the head somewhat to one side. 



CHAPTER VI. 

dissection of the throat. 

On looking into the mouth, we observe the tongue, 
and a soft curtain hanging from the palate bones, named 
the Velum Pendulum Palati, or soft Palate. The 
apex of the velum forms a small projecting body, termed 
the Uvula, or pap of the throat. From each side of 
the uvula, two muscular half-arches or columns are sent 
down, the anterior to the root of the tongue, the pos- 
terior to the side of the pharynx. Between these half- 
arches on each side are situated the glands termed 
Amygdalae, or Tonsils. The common opening behind 
the anterior arch is named the Fauces, or top of the 



MUSCLES ABOUT THE ENTRY OF THE FAUCES. 79 

Throat, from which there are six passages, two upward, 
being one to each nostril, called the Posterior Nares; 
two at the sides, called Eustachian Tubes, passing on 
each side to the ear; 1 two downward, of which the an- 
terior is the passage through the glottis and larynx into 
the trachea; the posterior, which is the largest, is the 
pharynx, or top of the oesophagus, and leads to the 
stomach. 



Muscles situated about the Entry of the Fauces. 

These consist of four pairs, and a single muscle in the 
middle. 

Fig. 23. 

The Pharynx laid open and viewed from behind. 

1. A Section carried transversely 

through the Base of the Skull. 
2, 2. The Walls of the Pharynx drawn 

to each side. 
The Posterior Nares, separated by 

the Vomer. 
The Extremity of the Eustachian 

Tube of one side. 
The Soft Palate. 
The Posterior Pillar of the Soft 

Palate. 

7. Its Anterior Pillar ; the Tonsil is 

seen in the niche between the 
two Pillars. 

8. The Root of the Tongue, partly 

concealed by the Uvula. 

9. The Epiglottis, overhanging (10) 

the Superior opening of the 
Larynx. 

11. The Posterior Part of the Larynx. 

12. The Opening into the (Esophagus. 

13. The External Surface of the 

(Esophagus. 

14. The Trachea. 



3, 3. 



5. 
6. 




1. Constrictor Isthmi Faucium — Arises, by a slen- 
der beginning, from the side of the tongue, near its root; 



1 A. probe may be introduced through the anterior nostrils into the 
Eustachian tube; the tube opens into the pharynx in a direction 
opposite to the space between the roots of the middle and inferior 
turbinated bones. 



80 PRACTICAL ANATOMY. 

thence running upward within the anterior arch, before 
the amygdala, it is 

Inserted into the middle of the velum pendulum palati, 
as far as the root of the uvula. It is here connected 
with its fellow, and with the beginning of the palato- 
pharyngeus. 

Situation, It forms the anterior half-arch. 

Use. To draw the velum toward the root of the 
tongue, which at the same time it raises, and, with its 
fellow, to contract the opening into the fauces. 

2. The Palato-Pharyngeus — Arises, by a broad 
beginning, from the root of the uvula in the middle of 
the velum pendulum palati, and from the tendinous ex- 
pansion of the circumflexus palati. The fibres pass 
along the posterior arch behind the amygdalae, and run 
backward to the superior and lateral part of the pharynx, 
where they are scattered, and mixed with those of the 
stylo-pharyngeus. 

Inserted into the edge of the upper and back part of 
the thyroid cartilage, and into the back part of the pha- 
rynx. 

Situation. It forms the posterior half-arch or column. 

Use. To draw the uvula and velum downward and 
backward, and pull the thyroid cartilage and pharynx 
upward ; to shut the passage into the nostrils, and, in 
swallowing, to thrust the food from the fauces into the 
pharynx. 

3. The Circumflexus, or Tensor Palati — Arises 
from the spinous process of the sphenoid bone, behind 
the foramen ovale, and from the Eustachian tube near 
its osseous part; runs down along the pterygoideus in- 
ternus, and forms a round tendon, which passes over the 
hook of the internal plate of the pterygoid process of 
the sphenoid bone, and soon spreads into a broad ten- 
dinous expansion. 

Inserted into the velum pendulum palati, and semi- 
lunar edge of the os palati. 

Situation. Its insertion extends as far as the suture 
which joins the two ossa palati. Some of its posterior 
fibres generally join with the constrictor pharyngis 
superior and palato-pharyngeus. 



MUSCLES OF THE TONGUE. 81 

Use. To stretch the velum, to draw it downward, and 
to one side. 

4. The Levator Palati — Arises, tendinous and 
fleshy, from the extremity of the petrous portion of the 
temporal bone, and from the Eustachian tube. 

Inserted into the whole length of the velum pendulum 
palati, as far as the root of the uvula, uniting with its 
fellow. 

Use. To draw the velum upward and backward, so as 
to shut the passage from the fauces into the mouth and 
nose. 

Azygos Uvul^i. — There are two which arise, fleshy, 
from the extremity of the suture which unites the ossa 
palati ; runs down the whole length of the velum, like a 
small earth-worm, adhering to the tendons of the cir- 
cumflexi palati. 

Inserted into the tip of the uvula. 

Use. To raise the uvula upward and forward, and 
shorten it. 

The Tongue. 

The tongue is connected by its root to the os hyoides, 
is principally formed by muscular structure. On its 
surface note its roughness, formed by papillae, eight or 
nine at its posterior part, arranged in a V-shaped figure 
(Papillae Maxima, or Oircumvallatde). Smaller and 
more numerous are others scattered over the tongue (the 
Papilla Medle, or Fungiformes). A third class, very 
numerous (the Papillae Minimje, or Filiformes). Three 
folds of mucous membrane pass from the back part of 
the tongue to the sides and centre of the Epiglottis 
(Glosso-Epiglottidean Folds), the middle one some- 
times called the Fr,enum of the Epiglottis. The Fora- 
men Caecum of Morgagni is in front of this. 

Muscles. 

Several of the muscles of the tongue have been de- 
scribed in the dissection of the neck. Those which enter 
into its structure proper are the 

5 



82 PRACTICAL ANATOMY. 

Lingualis, which arises from its root, and runs as 
far as the tip. 

Use. To shorten the tongue. 

SUPERFICIALIS LlNGlLE, TRANSVERSALES LlNGlL&I, 

and Verticales Lingua. — Their names indicate their 
direction. 

Muscles situated on the Posterior Part of the Pharynx. 

Of these there are three pair, and are better dissected 
after the muscles on the back of the neck are disposed 
of, in order to remove the head from its articulation 
with the atlas, taking with it the Pharynx, Larynx, and 
(Esophagus. 

1. The Constrictor Pharyngis Inferior. — This 
muscle arises from the outside of the ala of the thyroid 
cartilage, near the attachment of the thyreo hyoideus 
muscle, and from the side of the cricoid cartilage, near 
the crico-thyroideus. 

Inserted into the white line on the back part of the 
pharynx, where it is united to its fellow. 

Situation. This muscle covers the under part of the 
middle constrictor ; the superior fibres run obliquely 
upward, while the inferior fibres have a transverse di- 
rection. 

Use. To compress that part of the pharynx which it 
covers, and to raise it with the larynx a little upward. 

2. The Constrictor Pharyngis Medius — Arises 
from the superior edge of the cornu of the os hyoides, 
extending as far forward as the appendix ; and from the 
ligament which connects it to the thyroid cartilage. 
The superior fibres ascend obliquely, the others run 
more transversely. 

Inserted into the cuneiform process of the os occipitis, 
before the foramen magnum, and into a white line in the 
middle of the posterior surface of the pharynx, where it 
is joined to its fellow. 

Situation. The lower part of this muscle is covered 
by the muscle last described, while the upper part covers 
the inferior fibres of the constrictor superior. 



MUSCLES OF THE PHARYNX. 



83 



Use. To compress that part of the pharynx which it 
invests, and to draw it and the os hyoides upward. 

Fig. 24. 
A Side View of the Muscles or the Pharynx. 




1. The Trachea. 

2. The Cricoid Cartilage. 

3. The Cricothyroid Ligament. 

4. The Thyroid Cartilage. 

5. The Thyro-hyoid Ligament. 

6. The Hyoid Bone. 

7. The Stylo-hyoid Ligament. 

8. The (Esophagus. 

9. The Inferior Constrictor Muscle. 

10. The Middle Constrictor Muscle. 

11. The Superior Constrictor Muscle. 

12. The Stylo-pharyngeus Muscle 

passing down between the Su- 
perior and Middle Constrictors. 

13. The Upper Concave Border of the 

Superior Constrictor. At this 
point the muscular fibres of the 
Pharynx are deficient. 

14. The Pterygo - Maxillary Liga- 

ment. 

15. The Buccinator Muscle. 

16. The Orbicularis Oris Muscle. 

17. The Mylo-hyoid Muscle. 



3. Constrictor Pharyngis Superior — Arises, 
above, from the cuneiform process of the os occipitis, 
before the foramen magnum ; lower down from the 
pterygoid process of the sphenoid bone; from the upper 
and under jaw, near the alveolar process of the last 
dentes molares; and from the back part of the buc- 
cinator muscle. Some fibres also come from the root 
of the tongue, and from the palate. 

Inserted into a white line in the middle of the pos- 
terior surface of the pharynx. 

Situation. The larger part of this muscle is covered 
by the constrictor medius. 

Use. To compress the upper part of the pharynx 
and draw it forward and upward. 



84 



PRACTICAL ANATOMY. 



Muscles of the Larynx. 

The Larynx is composed of nine cartilages: 1. The 
Thyroid 'Cartilage, situated immediately below the os 
hyoides in the middle of the throat. 2. The Cricoid 
Cartilage, situated immediately below the thyroid car- 
tilage, betwixt it and the superior rings of the trachea. 
3. The Epiglottis, a broad triangular cartilage, very 

Fig. 25. 
Cartilages of the Larynx separated and seen in Front. 




1 to 4. Thyroid Cartilage. 

1. Vertical Ridge, commonly called 
Adam's Apple, formed by the 
union of the two Plates or 
Halves 

2. Right Half. 

3. Superior, and 

4. Inferior Horn of the Right Side. 
5, 6. Cricoid Cartilage. 

7. Right Arytenoid Cartilage. 



elastic, situated behind the root of the tongue, and cov- 
ering the entrance into the upper part of the larynx. 
4 and 5. The Arytenoid Cartilages, two small bodies, 
like peas, situated behind the thyroid cartilage, on the 
upper edge of the back part of the cricoid cartilage, 
and between the two alae or wings of the thyroid car- 
tilage. These two small cartilages form betwixt them- 
selves and the thyroid a longitudinal fissure, extending 
from before backward, which is called the Glottis, or 
Rima Glottidis, and leads to the trachea. 6 and 7. 
Cornicula Laryngis. These surmount the arytenoids. 



MUSCLES OF THE LARYNX. 85 

8 and 9. Cuneiform Cartilages (Cartilages of Wris- 
berg) in the Aryteno-Epiglottidean folds. 

The muscles situated about the glottis consist of four 
pair of small muscles, and a single one. 

1. The Crico-Aryt^enoideus Posticus — Arises, 
fleshy, from the posterior part of the cricoid cartilage, 
and is 

Inserted, narrow, into the back part of the arytenoid 
cartilage of the same side. 

Use. To open the rima glottidis a little, and, by 
pulling back the arytenoid cartilage, to render the liga- 
ment of the glottis tense. 

2. The Crico-Aryt^noideus Lateralis — Arises, 
fleshy, from the side of the cricoid cartilage, where it is 
covered by the ala of the thyroid cartilage. 

Inserted into the outer side of the arytenoid cartilage. 

Situation. It lies more forward than the last described 
muscle. 

Use. To open the rima glottidis, by pulling the liga- 
ments from each other. 

3. The Thyreo-Aryt^noideus — Arises from the 
middle and inferior part of the posterior surface of the 
thyroid cartilage ; runs backward, and a little upward, 
and is 

Inserted into the forepart of the arytenoid cartilage. 

Situation. It is situated more forward than the mus- 
cle last described. 

Use. To pull the arytenoid cartilage forward, and 
thus shorten the ligament of the larynx or glottis. 

Arytjenoideus Obliquus — Arises from the base of 
one arytenoid cartilage ; and, crossing its fellow, is 

Inserted into the tip of the other arytenoid cartilage. 

Use. When both act, they pull the arytenoid car- 
tilages toward each other. 

The single muscle is the 

Aryt^noideus Transversus, which arises from the 
whole length of one arytenoid cartilage, and passes across, 
to be 

Inserted into the whole length of the other arytenoid 
cartilage. 



86 



PRACTICAL ANATOMY. 



Fig. 26. 
Laryngeal Muscles. 




1. Epiglottis. 

2. Thyroid Cartilage. 

3. Cricoid Cartilage. 

4. Crico-arytenoideus Posticus. 

5. Arytenoideus Transversus. 

6. Arytenoideus Obliquus. 



Situation. It is situated anterior to the arytaenoidei 
obliqui. 

Use. To shut the rima glottidis, by bringing the aryte- 
noid cartilages together. 

Fig. 27. 
Muscles and Cartilages of the Larynx. 



1. Epiglottis. 

2. Cricoid Cartilage. 

3. Thyroid Cartilage. 

4. Crico-arytenoideus Lateralis. 

5. Thyro-arytenoideus. 




On each side of the larynx there are also a few mus- 
cular fibres, which are named as follows : 

1. Thyreo EpiaLOTTiDEUS — Arising, by a few pale 
separated fibres, from the thyroid cartilage, and 

Inserted into the epiglottis laterally. 



ORBIT OF THE EYE. 87 

Use. To draw the epiglottis obliquely downward, or, 
when both muscles act, directly downward ; and at the 
same time to expand it. 

2. The Arytjeno-Epiglottideus — Arises, by a few 
slender fibres, from the lateral and upper part of the 
arytenoid cartilage, and is 

Inserted into the epiglottis, along with the former 
muscle. 

Use. When both muscles act, to pull the epiglottis 
close upon the glottis. 

The Thyreo-Hyoideus and the Crico-Thyroideus were 
described with the muscles of the neck. The inside of 
the larynx is lined with a mucous membrane, and two 
folds will be seen running from the arytenoid cartilages 
to the angle of the thyroid; on either side these are the 
Vocal Cords. Between the cords of each side a cavity 
(the Ventricle), which communicates with another 
cavity at the upper and front part (the Sac of Hilton, 
or Sacculus Laryngis). The cavity above the upper 
cords (the glottis) ; space between the lower cords, the 
Rima GrLOTTIDIS. 



CHAPTER VII. 

DISSECTION OF THE ORBIT OF THE EYE. 

The globe or ball of the eye is situated about the 
middle of the orbit. It is connected to the bone by its 
muscles, and by the optic nerve; and all these parts are 
imbedded posteriorly in a soft, fatty substance, which 
fills up the bottom of the orbit. The tunica, or mem- 
brana conjunctiva, is seen lining the inner surface of the 
eyelids, and reflected from them over the anterior part 
of the globe of the eye, so that the back part of the eye- 
ball, and all the muscles and nerves, are situated behind 
it. This membrane must therefore be dissected away, 
the upper part of the orbit, which is formed by the os 



88 PRACTICAL ANATOMY. 

frontis, removed with a saw, and the fat surrounding the 
muscles, vessels, and nerves, cautiously dissected away 
with the scissors. 

Muscles situated within the Orbit. 

Seven muscles are contained within the orbit, of which 
one belongs to the upper eyelid, and six to the globe of 
the eye. 

1. The Levator Palpebrje Superioris — Arises, by 
a small tendon, from the upper part of the foramen opti- 
cum of the sphenoid bone; the tendon forms a broad 
flat belly. 

Inserted, by a broad thin tendon, into the upper eye- 
lid, adhering to the tarsal cartilage, which gives form to 
the eyelid. 

Use. To open the eye, by drawing the superior eye- 
lid upward. 

There are four straight muscles, or recti, belonging to 
the globe of the eye. These four muscles resemble each 
other, all arising by narrow tendons from the margin of 
the foramen opticum, where they surround the optic 
nerve; all forming strong fleshy bellies, and inserted, by 
broad, thin tendons, at the forepart of the globe of the 
eye, into the tunica sclerotica, or outer tunic of the eye, 
and under the tunica conjunctiva. 

2. The Levator Oculi, or Rectus Superior — Arises, 
by a narrow tendon, from the upper part of the foramen 
opticum of the sphenoid bone; it forms a fleshy belly, 
and is 

Inserted into the superior and anterior part of the 
tunica sclerotica, by a broad thin tendon. 

Situation. It lies below the levator palpebrge superioris. 
Use. To raise the globe of the eye. 

3. The Depressor Oculi, or Rectus Inferior — Arises 
from the inferior margin of the foramen opticum, and is 

Inserted into the inferior and anterior part of the 
tunica sclerotica. 

Use. To move the globe of the eye downward. 

4. The Adductor Oculi, or Rectus Internus — Arises 
from the inner part of the foramen opticum, and is 



MUSCLES WITHIN THE ORBIT. 



83 



Inserted into the inner and anterior part of the tunica 
sclerotica. 

It is the shortest of the four recti muscles. 

Use. To draw the eye toward the nose. 

5. The Abductor Oculi, or Rectus Externus— JLmes 
from the outer part of the foramen opticum. 

Inserted into the outer part of the tunica sclerotica. 

It is the longest of the recti. 

Use. To move the globe outward. 

The two next are oblique muscles. 



Fig. 28. 




A Side View of the Muscles of the Eyeball 

7, 



A. Ball of the Eye. 

1. Levator Palpebrge Superioris. 

2. Obliquus Superior, or Troch- 

lears Muscle. 

3. Trochlea of the last named 

Muscle. 

4. Rectus Superior Muscle. 

5. Rectus Inferior Muscle. 

6. Rectus Externus Muscle. 



Ligament of Zinn. 

8. Origin of the Superior Ob- 
lique Muscle 

9. Origin of the Rectus Ex- 
ternus. 

10. Obliquus Inferior Muscle. 

11. Optic Nerve. 

12 Malar Bone, divided. 
13. Upper Maxillary Bone. 



6. The Obliquus Superior, or Trochlearis — Arises, 
by a small tendon, from the margin of the foramen opti- 
cum, between the levator and abductor oculi. Its long 
slender belly runs along the inner side of the orbit to 

5* 



90 PRACTICAL ANATOMY. 

the internal angular process of the os frontis, where a 
cartilaginous pulley is fixed. The muscle then forms a 
tendon, which passes through the pulley, runs obliquely 
downward and outward, inclosed in a membranous 
sheath; and, becoming broader and thinner, is 

Inserted into the tunica sclerotica, about half way 
between the insertion of the levator oculi and the en- 
trance of the optic nerve. 

Use. To roll the globe of the eye, and turn the pupil 
downward and outward. 

7. The Obliquus Inferior — Arises, narrow, and 
principally tendinous, from the outer edge of the orbitar 
process of the superior maxillary bone, near its junction 
with the os unguis. It runs obliquely outward and back- 
ward, under the depressor oculi, and is 

Inserted, by a broad thin tendon, into the sclerotica, 
between the entrance of the optic nerve and the inser- 
tion of the abductor oculi. 

Use. To draw the globe of the eye forward, inward, 
and downward, and to turn the pupil upward. 

In the orbit we also meet with the Lachrymal 
Gland. This gland is of a yellowish color ; it is situ- 
ated in a depression of the os frontis near the temple. 
It adheres closely to the fat which surrounds the muscles 
and posterior convexity of the eye. It sends off several 
small ducts, which pierce the tunica conjunctiva lining 
the upper eyelid ; these ducts cannot be seen, unless the 
part be macerated in water, when they are filled with 
the liquid. 

The Palpebrje, or Eyelids, are two cartilaginous 
plates, semilunar in form, the upper the largest, connected 
to the internal and external angle of the orbit by fibrous 
tissue called the external and internal palpebral liga- 
ment (the internal one sometimes called the Tendo 
Oculi), above and below to the periosteal margin of the 
orbit by a fibrous membrane. 

The Puncta Lachrymalia are two small holes near 
the internal angle of the palpebrae, situated one in each 
eyelid. They lead into the Lachrymal Ducts, the 
ducts into the lachrymal sac. 



ARTERIES IN THE ORBIT OF THE EYE. 91 

The Lachrymal Sac is an oblong membranous bag, 
situated at the inner angle of the eye, in a depression 
formed by the os unguis and nasal process of the supe- 
rior maxillary bone. It receives the tears by the puncta 
lachrymalia, and from the sac they are conveyed into 
the nose by a Duct, named the Lachrymal or Nasal. 
The lower extremity of this duct opens into the nose on 
one side of the antrum maxillare, and under the os 
spongiosum inferius. A probe, with its extremity bent, 
may be introduced from the nose through this duct into 
the lachrymal sac. 

The Caruncula Lachrymalis is a small reddish granu- 
lated body, situated at the internal angle of the palpe- 
brse. 

Tensor Tarsi of Horner — Arises from the posterior 
superior surface of the os unguis, passes forward and 
outward, lying on the posterior face of the lachrymal 
ducts, upon w T hich it is inserted nearly as far as the 
puncta lachrymalia. 

Use. Draws the ducts toward the eye. 

Of the Vessels and Nerves met with in the Orbit of the 

Eye. 

Arteries. 

The Ophthalmic or Ocular Artery is a branch of 
the internal carotid. It enters the orbit from the basis 
of the cranium by the foramen opticum. It gives 
branches to the lachrymal gland, fat, muscle, and globe 
of the eye. One twig, named the A. Centralis Re- 
tina, enters the substance of the optic nerve, and is 
continued on to the retina ; twigs also pass to the eyelids 
and to the inner angle of the eye. The Arteria Fron- 
talis is a branch of this artery ; it is seen running to- 
ward the supra-orbitary notch or foramen, and is distrib- 
uted to the forehead. 

The Infra-Orbitary Artery is found in the lower 
part of the orbit ; it is the continued trunk of the in- 
ternal maxillary, entering the orbit by the sphenomax- 
illary slit. It is seen passing along the canal in the 



92 PRACTICAL ANATOMY. 

upper part of the great tuberosity of the os maxillare 
superius, and emerges on the face by the infra-orbitary 
hole. 

Veins. 

These correspond with the arteries; they discharge 
their blood partly into the branches of the external jugu- 
lar vein near the forehead and temples, and partly into 
the internal jugular. 

Nerves. 

1. The Optic Nerve is seen coming through the for- 
amen opticum, and entering the back part of the globe 
of the eye, to form the retina. 

2. The Nerve of the Third Pair, Motor Oculi, 
having entered the orbit through the superior orbitary 
fissure, or foramen lacerum, is divided into four branches. 

(1) The first runs upward, and subdivides into two 
nerves, of which one supplies the superior rectus, and the 
other the levator palpebrae superioris. 

(2) The second branch goes to the superior rectus, and 
is short. 

(3) The third branch supplies the obliquus inferior, 
and also gives off a twig, which assists in forming the 
lenticular ganglion. 

(4) The fourth branch supplies the internal rectus. 

3. The Nerve of the Fourth Pair, N. Patheticus or 
Trochlearis, enters the orbit by the superior orbitary fis- 
sure, and runs to the obliquus superior. 

4. The first branch of the Nerve of the Fifth Pair, 
named Ophthalmic or Orbitary, enters the orbit by the 
superior orbitary fissure, and divides into three branches. 

(1) The Frontal, Supra-orbitary or Superciliary 
Nerve, accompanies the frontal artery along the upper 
part of the orbit, close to the bone ; and having passed 
through the supra-orbitary notch, is distributed to the 
forehead. 

(2) The Nasal Nerve, or inner branch, runs toward 
the nose, and is distributed to the inner side of the 
orbit and to the nose. 



DISSECTION OF THE THORAX. 93 

(3) The Temporal or Lachrymal Branch supplies the 
lachrymal gland and the parts at the outer side of the 
orbit. 

The Lenticular Ganglion is a small ganglion, situ- 
ated within the orbit, formed by short branches of the 
ophthalmic nerve, and by a twig of the third pair. It 
sends off delicate nerves, which run along the sides of 
the optic nerve, and pierce the coats of the eye. 

5. The second branch of the Fifth Pair, called the 
Superior Maxillary Nerve, sends off a branch 
through the bony canal in the bottom of the orbit. 
This is the Infra-orbitary Nerve. It accompanies 
an artery of the same name, and emerges on the face 
by the Infra-orbitary Foremen. 

6. The trunk of the Sixth Pair of nerves passes 
through the sphenoidal fissure to the external rectus 
muscle. 

These delicate nerves are surrounded with fat, and 
demand great care in their dissection. 



CHAPTER VIII. 

DISSECTION of the thorax. 

Of the Muscles which lie upon the Outside of the Thorax. 
The Axilla. 

To expose these muscles, carry an incision from the 
top of the sternum along the median line to the ensiform 
cartilage, from thence obliquely upward through the 
axilla, and a few inches down the inner side of the arm. 
From the commencement of the first another along the 
clavicle to the acromion process. 

Notice the axilla, a conical cavity, having a muscular 
fold in front and behind. The former made by the Pec- 



94 PRACTICAL ANATOMY. 

toralis Major muscle, the latter by the Latissimus 
Dorsi muscle. 

In removing the integuments from the forepart of the 
thorax, the pectoralis major and interior edge of the del- 
toid muscle should be dissected in the course of their 
fibres ; and to do this, it will be necessary to remember 
that the fibres run obliquely from the sternum and cla- 
vicle to the upper part of the os humeri. 

Of the Female Mammae. — Two glandular bodies 
placed upon the great pectoral muscles, having only the 
fascia interposed, upon which they readily move. In the 
centre is placed the Nipple, about which are many se- 
baceous follicles. Ten or fifteen ducts (Tubuli Lacti- 
feri) commence at its extremity, and passing inward 
divide and subdivide, which ultimately end in enlarge- 
ments, from which pass off many others, to end finally 
in the ultimate lobules or vesicles of the organ. The 
lobules are supported by prolongations from the cellular 
capsule of the gland, which pass through its substance. 
Much adipose structure is usually intermixed with the 
lobules. 

Its bloodvessels from the axillary, intercostal, and in- 
ternal mammary trunks. 

Three pair of muscles are described in the dissection 
of the thorax. 

1. The Pectoralis Major — Arises, tendinous, from 
the anterior surface of the sternum, its whole length; 
fleshy, from the cartilages of the fifth, sixth, and some- 
times the seventh ribs, and from two anterior thirds of 
the clavicle. The fleshy fibres run obliquely across the 
breast, and, converging, form a strong, flat tendon, 
which is 

Inserted into the ridge of the os humeri on the out- 
side of the bicipital groove. 

Situation. The belly of this muscle is superficial. It 
is separated from the deltoid muscle by cellular mem- 
brane and fat, by the Cephalic Vein, and a small 
artery, named Humeral Thoracic. Its tendinous fibres, 
arising from the sternum, are interlaced with those of 
the opposite, so as to form a kind of fascia covering the 



MUSCLES OF THE THORAX. 



95 



bone; and the origins from the ribs are intermixed with 
the obliquus externus abdominis. The clavicular and 
thoracic portions of the muscle are separated by a line 
of cellular membrane which leads to the axillary vessels. 

Fig. 29. 




Front View of the Pectoralis Major Muscle. 

The tendon is covered by the anterior edge of the del- 
toid ; it forms the anterior fold of the armpit, and ap- 
pears twisted, for the fibres which proceed from the tho- 
racic portion of the muscle seem to pass behind those 
proceeding from the clavicle, and to be inserted into the 
os humeri somewhat higher up. 

Use. To move the arm forward, and obliquely up- 
ward, toward the sternum. 

The pectoralis major should be lifted up from its origin. 
This will expose the next two muscles. 

2. The Pectoralis Minor — Arises, by three tendin- 
ous and fleshy digitations from the upper edges of the 
third, fourth, and fifth ribs, near their cartilages ; it forms 
a fleshy triangular belly, w T hich becomes thicker and 
narrower as it ascends, and is 



96 PRACTICAL ANATOMY. 

Inserted, by a short flat tendon, into the anterior part 
of the coracoid process of the scapula. 

Situation. The belly of this muscle is covered by the 
pectoralis major: the tendon passes under the anterior 
edge of the deltoid, and is connected at its insertion with 
the origins of the coraco-brachialis, and of the short head 
of the biceps flexor cubiti, and also with the coraco- 
acromial ligament. 

Use. To draw the scapula forward and downward, and, 
when that bone is fixed, to elevate the ribs. Above its 
insertion notice some arteries presently to be described. 

Fig. 30. 




A Front View of the Subclavius and Pectoralis Minor Muscles. 
1. Subclavius. 2. Pectoralis Minor. 

3. The Subclavius — Arises, by a flat tendon, from 
the cartilage of the first rib, and forms a broad fleshy 
belly, which is 

Inserted into the inferior surface of the clavicle, begin- 
ning about one inch from the sternum, and continuing as 
the ligamentous connection of the clavicle to the coracoid 
process. 



DISSECTION OF THE AXILLA. 97 

Situation. This muscle is situated between the clavicle 
and sternum, concealed by the pectoralis major, and an- 
terior part of the deltoides. 

Use. To draw the clavicle downward and forward, and 
perhaps to elevate the first rib. 

Having lifted up the pectoralis minor from its origin, 
the situation of the subclavian vessels which pass under 
the clavicle, and over the first rib, may be seen. 

Dissection of the Axilla. 

The axilla is formed by two muscular folds, which 
bound a middle cavity. The anterior fold is formed by 
the pectoralis major passing from the thorax to the arm, 
the posterior by the latissimus dorsi coming from the 
back. 

In the intermediate cavity there is a quantity of cel- 
lular membrane and absorbent glands and fat, covering 
and connecting the great vessels and nerves; and this is 
not exactly similar to the fat in other parts of the body; 
it is more granulated, watery, and of a reddish color; it 
surrounds the great vessels and nerves, rendering the 
dissection both tedious and difficult. The lymphatic 
glands here are continuous under the clavicle with those 
of the neck. 

The Axillary Vein will be found lying anterior to 
the artery, that is, nearer the integuments. The axil- 
lary vein receives branches corresponding to the ramifi- 
cations of the artery. Passing under the clavicle, it 
becomes the subclavian vein, and runs over the first rib, 
and before the anterior scalenus muscle into the thorax. 

Deeper seated, and immediately behind the axillary 
vein, lies the Axillary Artery. It is seen coming 
from under the clavicle; from under the arch formed by 
the pectoralis minor, it comes over the middle of the 
first rib, and between the anterior and middle scaleni 
muscles. In the axilla it is surrounded by the meshes 
of the axillary nerves, and runs under the tendon of 
pectoralis minor along the inferior edge of the coraco- 
brachial muscle ; when it has passed to the tendon of 



98 PRACTICAL ANATOMY. 

the latissimus dorsi muscle, it assumes the name of the 
Brachial Artery. 

The branches of the axillary artery are 

1. A. Mammaria Externa, called also A. Thoracic^ 
Externse. — The external mammary artery consists of 
four or five branches which run downward and forward 
obliquely over the chest. These branches sometimes 
come off separately from the axillary artery, at other 
times by one or two common trunks, which subdivide. 
They supply the pectoral muscles and mamma. Some 
of their branches pass to the muscles of the shoulder, 
to the side of the chest, and to the muscles on the inside 
of the scapula. They are as follows: 

a. Thoracico Acromialis — going toward the fissure 
between the deltoid and pectoralis major. 

b. Thoracico Superior — to the pectoralis major. 

c. Thoracico Longa — along the border of the pec- 
toralis minor and side of the chest. 

d. Thoracico Axillaris — to the glands and cellular 
tissue of the armpit. 

2. A. Subscapulars arises from the under and 
back part of the axillary artery, attaches itself to the 
inferior costa of the scapula, where it splits into two 
great branches: 1. The Dorsalis Scapula, a large 
branch, which passes to the outer surface of the scapula 
below the spine, and has its principal ramifications close 
upon the bone. 2. The other branch (which is larger) 
passes to the inner surface of the scapula, supplies the 
subscapularis, and sends branches downward to the mus- 
cles of the back and loins. (See Fig. 30.) 

3. Arteria Circumflexa Humeri Posterior arises 
from the lower and forepart of the axillary artery, and 
runs backward close to the bone, surrounds its neck, 
and is lost on the inner surface of the deltoid; it gives 
also twigs to the joint and neighboring muscles. It is 
accompanied by the Circumflex Nerve. 

4. A. Circumflexa Anterior is a much smaller 
artery, often a branch of the circumflexa posterior; it 
encircles the neck of the bone on its forepart, and is 



DISSECTION OF THE AXILLA. 99 

lost on the inner surface of the deltoides, where it inos- 
culates with the posterior circumflex artery. 

The Great Brachial Nerves accompany the sub- 
clavian artery over the first rib. In the axilla they are 
united by numerous cross branches, forming the Axil- 
lary or Brachial Plexus, which is continued from the 
clavicle as low as the edge of the tendon of the latissi- 
mus dorsi, and which surrounds the axillary artery with 
its meshes. 

From the axillary plexus seven nerves pass off. 

1. Nervus Supra-scapularis. — This nerve comes 
off from the upper edge of the plexus; it crosses the 
axilla at the highest part, runs toward the superior costa 
of the scapula, accompanies the external scapular artery 
through the semilunar notch, and supplies the muscles 
on the posterior surface of the scapula. 

2. N. Circumflexus lies deep ; it passes from the 
back part of the plexus, goes backward round the neck 
of the bone, accompanying the posterior circumflex 
artery, and is distributed to the deltoid and the muscles 
on the outside of the arm. Small nerves also pass from 
the axillary plexus to the subscapular muscle (subscapu- 
lar), the teres major, latissimus dorsi, and pectoral 
muscles. 

3. The External Cutaneous Nerve, or Nervus Mus- 
culo-cutaneus. 

4. The Median Nerve. 

5. The Ulnar Nerve. 

6. The Musculo- Spiral Nerve. 

7. The Internal Cutaneous Nerve. 

8. The Lesser Internal Cutaneous, or Nerve of Wris- 
berg, formed by a filament from the second intercosto 
humeral, and another from the axillary plexus. 

At this exposure of parts a nerve may be observed 
descending close along the thorax upon the serratus 
magnus muscle. This is the Long Thoracic or Exter- 
nal Respiratory of Bell, and comes from the fourth 
and fifth cervical nerves. Two others come through the 
intercostal spaces, the Intercosto Humeral. They 



100 PRACTICAL ANATOMY. 

come from the intercostal nerves, and mingle with the 
axillary nerves. 

Six of these nerves will be described in the dissection 
of the arm and forearm. 



CHAPTER IX. 

DISSECTION OF THE SUPERIOR EXTREMITY. 

Of the Shoulder and Arm. 

An incision carried down the middle of the arm and 
integuments reflected, will expose the parts properly 
for dissection. The arm is invested with a superficial 
fascia, mingled with fat, in and beneath which are situ- 
ated important veins. Beneath the superficial fascia is 
the Deep Fascia, consisting of fibres running circularly 
and longitudinally. This fascia is very thin over the 
deltoid. Strong at the internal condyle, and on the back 
of the forearm, sending processes in between the mus- 
cles and furnishing to them a surface of origin. 

In removing the integuments, we meet with several 
cutaneous veins and nerves. 

The cutaneous veins 1 of the upper extremity are the 
following : 

1. The Basilic Vein is seen arising from a small 
vein on the outside of the little finger, named Salvatella. 
It then runs along the inside of the forearm near the 
ulna, receiving the internal and external ulnar veins 
from the anterior and posterior surface of the fascia. It 
passes over the fold of the arm near the inner condyle 
of the humerus. It ascends along the arm, becoming 
more deeply seated, and included in the sheath which 
invests the brachial artery. As it approaches the neck 

1 The veins are described from their origin in the forearm for the 
sake of perspicuity. 



OF THE SHOULDER AND ARM. 



101 



of the humerus, it sinks deep betwixt the folds of the 
armpit, and terminates in the axillary vein, which may 
be considered as a continuation of the basilic vein. It 
communicates with the deeper-seated veins, and receives 
numerous branches from the muscles. 

Fig. 31. 
Superficial Veins of the Superior Extremity. 



a. Commencement of the Cephalic Vein. 

b. Main Trunk of Cephalic Vein. 

c. Anterior Branch of Basilic Vein. 
Posterior Branch of Basilic Vein. 
Basilic Vein. 
Median Vein. 
Median Basilic Vein. 

h. Median Cephalic Vein. 
i. Biceps Muscle. 



d. 

€. 
/• 

9> 



2. The Cephalic Vein begins on the back of the 
hand, between the thumb and metacarpal bone of the 
forefinger, by a small vein, named Cephalica Pollicis. 
It runs along the radius between the muscles and in- 



102 PRACTICAL ANATOMY. 

teguments, receiving the internal and external radial 
veins. It passes over the bend of the arm near the ex- 
ternal condyle, and ascends along the outside of the arm 
near the outer edge of the biceps flexor cubiti. It then 
runs betwixt the edge of the deltoid and pectoral mus- 
cles, dips down under the clavicle, and enters the sub- 
clavian vein. In all this course the cephalic vein receives 
branches. 

3. The Median Vein. — Several veins are seen run- 
ning along the middle of the anterior part of the fore- 
arm. The trunk formed by these veins is called the 
Mediana Major. It ascends on the flat part of the fore- 
arm, betwixt the basilic and cephalic veins, and bifur- 
cates at the fold of the arm into two branches : 1. The 
Mediana Basilica, passing off obliquely to join the 
basilic vein; 2. The Mediana Cephalica, which joins the 
cephalic. 

The cutaneous nerves of the arm are seen ramifying 
above the muscles; they consist of 

1. The Internal Cutaneous Nerve, a branch of the 
axillary plexus. It is seen accompanying the basilic 
vein, and twisting its fibres over it. It descends along 
the inside of the arm, crosses over the forepart of the 
elbow-joint, and, in the dissection of the forearm, will be 
seen dividing itself into twigs, which ramify between the 
fascia and integuments, and are distributed to the inside 
of the forearm and wrist. 

2. The upper part of the arm receives cutaneous 
nerves from the branches of the dorsal nerves, which 
come out of the thorax between the ribs. 

3. The shoulder and back part of the scapula receive 
twigs from the cervical nerves. 

4. The external cutaneous, ulnar, and spiral nerves, 
also send twigs to the integuments of the arm and fore- 
arm. 

Muscles situated on the Shoulder and Arm. 

These are ten in number. 

1. The Deltoides — Arises, tendinous and fleshy, 
from the posterior third of the clavicle, from the whole 



MUSCLES OF THE SHOULDER AND ARM. 



103 



edge of the acromion, and from the lower margin of 
the whole spine of the scapula. From^ these several 
origins the fibres run in different directions, and con- 
verge to be 

Inserted, tendinous, into a triangular rough surface on 
the outer side of the os humeri, near its middle. 

Fig. 32. 
A View of the Deltoid Muscle. 



1. Body of the Muscle. 

2. Its Insertion into the Clavicle. 

3. Its insertion into the Spine of 

the Scapula. 

4. Its Insertion into the Humerus. 




Situation. This muscle is entirely superficial, except 
where the thin fibres of the platysma myoides arise from 
its anterior surface. It arises from the same extent of 
bone as the trapezius is inserted into. It is a coarse 
muscle, consisting of large fasciculi of fibres. It con- 
ceals the insertion of the pectoralis major, and the 
origins of the biceps flexor cubiti and eoraco-brachialis, 
and covers the whole of the forepart and outside of the 
shoulder-joint. Its external surface is quite fleshy; but, 
on cutting it across, its internal surface is found ten- 
dinous; and where it slides over the great tuberosity of 
the humerus there is a large bursa. 

From the insertion of the deltoid to the outer con- 



104 PRACTICAL ANATOMY. 

dyle of the os humeri is extended an Intermuscular 
Ligament, which separates the muscles on the anterior 
part of the arm from those on the posterior part, and 
gives attachment to the fibres of both. It is named the 
External Intermuscular Ligament. It is only the deep 
fascia. 

Use. To draw the arm directly upward, and to move 
it a little forward and backward, according to the dif- 
ferent directions of its fibres. Reflect it from the scapula 
and clavicle, that you may expose more completely the 
muscles on the dorsum of the former bone. 

The following two muscles, which fill up the posterior 
surface of the scapula, are covered by a fascia, which ad- 
heres to the spine and edges of that bone. On dissecting 
off this fascia, the fleshy fibres of the muscles will be 
found arising from its inner surface. 

2. The Supra-Spinatus — Arises, fleshy, from all that 
part of the base of the scapula that is above its spine, 
from the superior costa as far forward as the semilunar 
notch, from the spine itself, and from the concave sur- 
face betwixt it and the superior costa. The fleshy fibres 
terminate in a tendon which passes under the acromion, 
slides over the neck of the scapula (to which it is con- 
nected by loose cellular membrane), adheres to the cap- 
sular ligament of the shoulder-joint, and is 

Inserted into the anterior and superior part of the 
great tuberosity near the head of the os humeri. 

Situation. This muscle fills up the fossa or cavity 
above the spine of the scapula, and is entirely concealed 
by the fibres of the trapezius. 

Use. To raise the arm. 

The supra-scapular artery and nerve pass through this 
fossa. 

3. The Infra- S pin atus — Arises, principally fleshy, 
from the lower part of the spine of the scapula as far 
back as the triangular flat surface ; from the base of the 
bone below the spine to near the inferior angle; from the 
posterior ridge of the inferior costa; and from all the 
dorsum of the bone below the spine. The fibres ascend 
and descend toward a middle tendon, which runs for- 



MUSCLES OF THE SHOULDER AND ARM. 



105 7 



ward over the neck of the bone, and adheres to the cap- 
sular ligament. 

Inserted, by a strong short tendon, into the middle 
part of the great tuberosity of the os humeri. 

Situation. This muscle is in part concealed by the 
deltoid, and the trapezius passes over its upper and back 
part; but a considerable portion of the belly of this 

Fig. 33. 




Muscles of the Scapula. 

1. Supra- spin atus. 3. Teres Minor, 

2. Infra-spinatus. 4. Teres Major. 

muscle is seen betwixt these two muscles. It is inserted 
below the tendon of the supra-spinatus. 

Use. To roll the humerus outward, to assist in rais- 
ing the arm, and in moving it outward when raised. 

4. The Teres Minor — Arises, fleshy, from the nar- 
row depression between the two ridges in the inferior 
costa of the scapula, extending from the neck of the 
bone to within an inch or two of the inferior angle. It 
passes forward along the inferior edge of the infra-spin- 
atus, adheres to the capsular ligament of the shoulder- 
joint, and is 

Inserted, tendinous and fleshy, into the lower and 
back part of the great tuberosity of the os humeri. 

Situation. It is inserted below the tendon of the infia- 

6 



106 PKACTICAL ANATOMY. 

spinatus. Its origin lies between the infra- spinatus and 
teres major, and partly concealed by them. Its inser- 
tion is concealed by the deltoid. The fascia which 
covers the infra-spinatus envelops also the teres minor ; 
and the two muscles are in some subjects so closely 
united as to be with difficulty separated. 

Use. To draw the humerus downward and backward, 
and to roll it outward. 

5. The Teres Major — Arises from an oblong, rough, 
flattened surface, at the inferior angle of the scapula. It 
forms a thick belly, which passes forward and upward 
toward the inside of the arm. 

Inserted, by a broad thin tendon, into the ridge of the 
os humeri, at the inner side of the bicipital groove. 

Situation. Its belly passes before the long head of 
the triceps extensor cubiti. Its tendon is inserted along 
with the tendon of the latissimus dorsi. Observe the 
relative situation of these tendons ; they both pass under 
the coraco-brachialis and short head of the biceps flexor, 
to reach the place of their insertion. They appear at 
first inseparably united, but on dividing them with some 
care we find an intermediate cavity lubricated with 
synovia. 

Use. To roll the humerus inward, and to draw it 
backward and downward. 

6. The Subscapulars — Arises, fleshy, from all the 
base of the scapula internally, from the superior and 
inferior coste, and from the whole internal surface of 
the bone. It consists of tendinous and fleshy bundles, 
which converge, slide over the inner surface of the neck 
of the scapula, pass in the hollow under the root of the 
coracoid process, and adhere to the inner part of the 
capsular ligament of the shoulder-joint. 

Inserted, by a strong tendon, into the lesser tuber- 
osity near the head of the os humeri. 

Situation. The whole of this muscle is concealed by 
the scapula and muscles of the shoulder. It lies betwixt 
that bone and the serratus magnus. 

Use. To roll the os humeri inward, and to draw it to 
the side of the body. 



MUSCLES OF THE SHOULDER AND ARM. 



107 



7. The Biceps Flexor Cubtti — Arises by two heads. 
The first and outermost, called the Long Head, arises, 
by a strong tendon, from a smooth surface in the upper 



Fig. 34. 




Muscles of the Scapula. 



1. Subscapulars. 

2. Teres Major. 



3. Part of Triceps. 

4. Deltoid Muscle. 



edge of the glenoid cavity of the scapula. It passes 
over the head of the os humeri, within the capsular liga- 
ment of the shoulder joint, and enters the bicipital 
groove. It forms a strong fleshy belly. The second 
and innermost, called the Short Head, arises, tendinous, 
from the lower part of the coracoid process of the scap- 
ula, in common with the coraco-brachialis, and sends off 
a fleshy belly. 

These two fleshy bellies form a thick mass, and, below 
the middle of the arm, become inseparably united. They 
send off a strong tendon, which passes into the forepart 
of the elbow-joint. 

Inserted into the posterior rough part of the tubercle 
of the radius. A bursa mucosa is placed between the 
tendon and front of the tubercle. 

Situation. The tendon of the long head cannot be 
seen till the capsular ligament of the shoulder is opened. 
The two origins are concealed by the deltoides and pec- 
toralis major; and, at the bend of the elbow, its tendon 
sends off from its inside an aponeurosis (Bicipital), 



108 



PRACTICAL ANATOMY. 



which assists in forming the fascia of the forearm, and 
covers the brachial artery and median nerve. 

Fig. 35. 

Muscles of the Anterior Brachial Region, the Anterior half 
of the Deltoid being cut away. 




Subscapularis Muscle. 

Biceps. 

Teres Major. 

Brachialis Anticus. 

Tendon of the Pectoralis Major. 

Internal Head of the Triceps. 

Tendinous Expansion of the Bi- 
ceps. 

Extremity of the Pectoralis 
Minor. 

Coraco Brachialis. 

Long Head of the Biceps. 

Short Head of the Biceps. 

Coracoid Process of the Scapula. 



Use. To turn the hand supine, to bend the forearm 
on the arm, and the arm on the shoulder. 

8. The Coraco-Brachialis — Arises, tendinous and 
fleshy, from the middle part of the apex of the coracoid 
process of the scapula. Its fibres, as it descends, also 
arise from the edge of the short tendon of the biceps 
flexor cubiti. It forms aflat fleshy belly which is always 
perforated by the nerve, named Musculo-Cutaneous Ex- 
tern us. 

Inserted, tendinous and fleshy, about the middle of 
the internal part of the os humeri, into a rough ridge. 

Situation. This muscle is much connected with the 



MUSCLES OF THE SHOULDER AND ARM. 109 

short head of the biceps flexor cubiti. In the arm it 
lies behind, and on the inside of the biceps, and is con- 
cealed partly by the pectoralis major and deltoides. It 
is inserted immediately below the tendons of the latis- 
simus dorsi and teres major, and before the brachialis 
externus. The Axillary Artery is on its inner edge 
and the median nerve. 

The internal intermuscular ligament (Deep Fascia of 
the Arm) is seen extending from the lower part of this 
muscle along a ridge to the internal condyle, and sepa- 
rating the brachialis internus from the brachialis ex- 
ternus, or third head of the triceps extensor cubiti. 

Use. To move the arm upward and forward. 

9. The Brachialis Internus — Arises from the mid- 
dle of the os humeri, by two fleshy slips, which pass on 
each side of the insertion of the deltoid muscle ; fleshy 
from all the forepart of the bone below, nearly as far as 
the condyles. The fibres converge, pass over the elbow- 
joint, and adhere to the capsular ligament. 

Inserted, by a strong short tendon, into the rough 
surface immediately below the coronoid process of the 
ulna. 

Situation. The belly is almost entirely concealed by 
the biceps flexor cubiti, excepting a small portion which 
projects beyond the outer edge of that muscle. The 
tendon dips down betwixt the supinator radii longus and 
pronator teres, crosses under the tendon of the biceps 
flexor, and is inserted on the inside of that tendon. 

Use. To bend the forearm. 

10. The Triceps Extensor Cubiti is the great mus- 
cle which covers all the back part of the arm. It arises 
by three heads. The first, or long head, arises, by a 
broad tendon, from the inferior costa of the scapula 
near its cervix, and forms a large belly, which covers 
the back part of the os humeri. The second, or short 
head, arises, on the outer and back part of the os humeri, 
by an acute tendinous and fleshy beginning, from a ridge 
which runs from the back part of the great tuberosity 
toward the outer condyle. They also arise from the 
surface of bone behind the ridge, and from the inter- 



110 PRACTICAL ANATOMY. 

muscular ligament which separates them from the mus- 
cles on the forepart of the arm. The third head, called 
Brachialis Externus, arises, by an acute beginning, 
from the inside of the os humeri above its middle, and 
from a ridge extending to the inner condyle, from the 
surface behind this ridge, and from the internal inter- 
muscular ligament. 

The three heads unite above the middle of the os 
humeri, and invest the whole back part of the bone. 
They form a thick strong tendon, which is 

Inserted into the rough back part of the process of the 
ulna, called Olecranon, and partly into the condyles of 
the os humeri, adhering firmly to the capsular ligament. 

Between the first and third head passes the musculo- 
spiral nerve. The Ulnar Nerve rests upon the front 
part of the triceps muscle, accompanied by the Inferior 
Profunda artery from the brachial. The Superior Pro- 
funda Artery accompanies the musculo-spiral nerve. 

Situation. The long head, where it arises from the 
scapula, is concealed by the deltoid; it arises betwixt the 
teres minor and teres major. The short head arises im- 
mediately below the insertion of the teres minor. The 
tendon of the triceps sends off a thin fascia, which covers 
the triangular surface of the ulna, on which we commonly 
lean. Numerous fibres are also sent off, to assist in form- 
ing the fascia of the forearm. 

Use. To extend the forearm. The long head will also 
assist in drawing the arm backward. 

Dissection of the Fascia and Muscles situated on the 
Cubit or Forearm. 

On removing the integuments of the forearm, we find 
a strong fascia investing all the muscles. It is attached 
to the condyles, and it adheres firmly to the olecranon of 
the ulna. It receives, on the posterior part, a great addi- 
tion of fibres from the tendon of the triceps extensor; 
and on the forepart of the arm, it appears to be a con- 
tinuation of the aponeurosis which is sent off from the 
biceps flexor cubiti. 



MUSCLES OF THE FOREARM. Ill 

Above the fascia we meet with several cutaneous veins 
and nerves. The veins have been already described; the 
nerves are twigs of the branches of the brachial plexus, 
principally internal and external cutaneous. 

The relative situation of the vessels at the bend of the 
arm should be well attended to. The cutaneous veins 
situated here vary much in size. The vena basilica is 
seen running over the forepart of the bend of the arm 
near the inner condyle, the vena cephaliea situated near 
the outer condyle ; and each of these veins receives a 
branch passing obliquely from the vena mediana. These 
vessels lie above the fascia, while the brachial artery lies 
just beneath the fascia, in a hollow resembling that of 
the axilla. It descends over the joint near the inner con- 
dyle, on the inside of the tendon of the biceps flexor cu- 
biti, and under the aponeurosis sent off from that muscle 
to the common fascia of the forearm. It lies imbedded 
in cellular substance, betwixt the pronator teres and flexor 
muscles of the wrist and fingers on one side, and the su- 
pinator longus and extensor muscles on the other. In 
this hollow it divides into the radial ulnar and interosseal 
arteries. The artery is accompanied by two veins, and 
on its inner side runs the radial nerve. 

Muscles situated on the Forepart of the Cubit, and 
arising from the Inner Condyle of the Os Humeri. 

These are eight in number, and may be divided into 
two classes, the superficial and the deep seated. 

First, the superficial. 

All the muscles passing from the inner condyle may 
be said to arise by one common tendinous head from the 
condyle, and this head may be said to divide into the 
different muscles ; but they will be here described as 
arising distinct from the condyle. It must, however, be 
recollected that their origins are intimately connected by 
intermuscular fascia, and that they cannot be separated 
without dividing some of their fibres. 

1. The Pronator Radii Teres— Arises, tendinous 
and fleshy, from the anterior surface of the inner con- 



112 PRACTICAL ANATOMY. 

dyle of the os humeri, and from the coronoid process of 
the ulna. It also arises from the fascia of the forearm. 
The fibres pass outward, run by the side of the tubercle 
of the radius, and pass oyer the outer edge of that bone, 
to be 

Inserted, tendinous and fleshy, into a rough surface 
on the back part of the radius about its middle. 

Situation. Of the muscles which pass from the inter- 
nal condyle, the pronator teres is situated nearest the 
outer edge of the arm. Its tendon, to arrive at its place of 
insertion, passes under the belly of the supinator longus. 

Use. To roll the radius, together with the hand, in- 
ward. 

2. The Flexor Carpi Radialis — Arises>bv a narrow- 
tendinous beginning, from the lower and forepart of the 
internal condyle of the os humeri; fleshy from the fascia 
and intermuscular ligaments, and from the upper end of 
the ulna. It forms a thick belly, which runs down the 
forearm, and terminates in a flat tendon. This tendon 
passes under the annular ligament 1 of the wrist, runs 
through a groove in the os trapezium, and is 

Inserted into the forepart of the base of the metacar- 
pal bone of the forefinger. 

Situation. This muscle is situated immediately under 
the fascia, excepting its upper extremity, over which the 
pronator teres crosses. Its insertion cannot be seen till 
the palm of the hand is dissected, where it will be found 
concealed by the muscles of the ball of the thumb. 

Use. To bend the hand and to assist in its pronation. 

3. The Palmaris Longus — Arises, by a slender ten- 
don, from the forepart of the inner condyle of the os 



1 The annular ligament of the wrist consists of two parts : 1. The 
ligamentum carpi transversale externum passes from the styloid pro- 
cess of the ulna and os pisiforme, transversely, over the back of the 
wrist, and spreads out broad, to be affixed to the styloid process of 
the radius. Under it pass the tendons of the extensor muscles. 2. 
The ligamentum carpi transversale internum is a strong ligament, 
which passes across the forepart of the wrist. It arises from the os 
pisiforme and os unciform e on the inner edge of the wrist, and is 
attached to the os scaphoides and os trapezius on the outer edge. 
Under it pass the tendons of the flexor muscles. 



MUSCLES OF THE FOREARM. 



113 



humeri, and fleshy from the intermuscular ligament; it 
forms a short fleshy belly, which soon sends off a long 
slender tendon. This tendon descends along the fore- 
arm, and is 

Fig. 36. 

The Muscles or the Front of the Forearm. 



9, 
10. 
11 
12. 

13, 
14, 



Lower part of the Biceps. 

Part of the Brachialis Interims. 

Edge of the Triceps. 

Pronator Radii Teres. 

Flexor Carpi Radialis. 

Palmaris Longus. 

One of the Divisions of the Flexor Sub- 
lines Digitorum. 

Flexor Carpi Ulnaris. 

Palmir Fascia. 

Palmar Brevis Muscle. 

Abductor Pollicis Manus. 

Portion of the Flexor Brevis Pollicis 
Manus. 

Supinator Radii Longus. 

Extensor Ossis Metacarpi Pollicis curv- 
ing around the lower Border of the 
Forearm. 




Inserted, near the root of the thumb, into the liga- 
mentum carpi transversale internum, and into a tendin- 
ous membrane that covers the palm of the hand named 
Palmar Fascia, or Aponeurosis Palmaris. 

Situation. It arises betwixt the flexor carpi radialis 
and flexor ulnaris. This muscle is sometimes wanting. 

Use. To bend the hand, and stretch the palmar 
aponeurosis. 

4. The Flexor Carpi Ulnaris — Arises, tendinous, 

6* 



114 PRACTICAL ANATOMY. 

from the inferior part of the internal condyle of the os 
humeri; tendinous and fleshy, from the inner side of the 
olecranon, and by a tendinous expansion from the poste- 
rior ridge of the ulna, to near the lower end of the bone. 
It also arises from the intermuscular fascia and fascia of 
the forearm. The fibres pass obliquely forward into a 
tendon which runs over the forepart of the ulna, and is 

Inserted into the os pisiforme, and sometimes sends 
its fibres over a small ligament which goes to the base 
of the metacarpal bone of the little finger. 

Situation. This muscle runs along the inner edge of 
the forearm, between the flexor sublimis on the forepart, 
and the extensor carpi ulnaris on the back part of the 
ulna. 

Use. To bend the hand. 

5. The Flexor Sublimis Perforatus — Arises, ten- 
dinous and fleshy, from the under part of the internal 
condyle of the os humeri; tendinous, from the lower part 
of the coronoid process of the ulna; fleshy, from the 
tubercle of the radius, from the middle of the forepart of 
that bone, and from the middle third of its outer edge. 
These origins form a strong fleshy mass, which sends off 
four tendons. These tendons are connected by cellular 
membrane, and pass together under the annular liga- 
ment of the wrist; after which they separate, become 
thinner and flatter, pass along the metacarpal bone and 
first phalanx of each of the fingers, and are 

Inserted into the anterior and upper part of the second 
phalanx, each tendon being, near the extremity of the 
first phalanx, divided for the passage of a tendon of the 
flexor profundus. 

Situation. To expose the origin of this muscle, the 
bellies of the pronator teres, flexor carpi radialis, and 
palmaris longus, must be detached from the condyle. It 
descends along the forearm under these muscles, but a 
part of it is seen projecting toward the inner edge of the 
arm, betwixt the tendons of the palmaris longus and 
flexor carpi ulnaris. It arises from the radius below 
the insertion of the biceps flexor cubiti. Its tendons 
will be seen in the dissection of the palm of the hand. 



ARTERIES OF THE FOREARM. 



115 



Use. To bend the second joint or phalanx of the 
fingers. 

Notice the following bloodvessels and nerves, which 
will be discussed in detail, when the dissection of the 
arm has been finished. 



Fig. 37. 
A View of the Arteries of the Forearm. 



1. The Lower Part of the Biceps 

Muscle. 

2. The Inner Condyle of the Humerus, 

with the Humeral Origin of the 
Pronator Radii Teres and Flex- 
or Carpi Radialis Muscles cut 
across. 

3. The deep portion of the Pronator 

Teres Muscle. 

4. The Supinator Longus Muscle. 

5. The Flexor Longus Pollicis. _ 

6. The Pronator Quadratus. 

7. The Flexor Digitorum Profundus. 

8. The Flexor Carpi Ulnaris. 

9. The Anterior Annular Ligament. 

The figure is placed on the Ten- 
don of the Palmaris Longus Mus- 
cle, divided close to its insertion. 

10. The Brachial Artery. 

11. The Great Anastomotic Artery. 

12. The Radial Artery. 

13. The Radial Recurrent Artery. 

14. The Superficialis Volse Artery. 
15 The Ulnar Artery. 

16. Its Superficial Palmar Arch giving 

Digital Branches to three fingers 
and a half. 

17. The Great Artery of the Thumb 

(Magna Pollicis). 

18. The Posterior Ulnar Recurrent. 

19. The Anterior Interosseous Artery. 

20. The Posterior Interosseous, as it is 

passing through the Interosseous 
ligament. 




Brachial Artery at the bend of the arm, the median 
nerve on its inner side. The artery divides into Radial 
and Ulnar. 

The Radial crosses to the radial side of the arm, at 



116 PRACTICAL ANATOMY. 

v 

the root of the thumb passes under its extensor tendons. 
Its branches are 

Recurrens Radialis, toward external condyle. 

Muscular, to the muscles. 

Superficialis Vol/E, to the ball of the thumb. 

Carpal. Anterior and Posterior. These are all 
that can be seen at the present stage of the dissection. 

Radial Nerve, to the outside of the artery, 

A. Ulnaris. — Its first part deep under several mus- 
cles which arise from the internal condyle, and not visible, 
emerges on the ulnar side of arm, and passes down the 
arm between the Flexor Carpi Ulnaris and Flexor 
Sublimis Digitorum, over the annular ligament into 
the hand, to form the arcus sublimis. The ulnar nerve 
is to its ulnar, or inner border. Its branches are 

Recurrens Ulnaris — Passes back toward the inter- 
nal condyle. 

Interossea — Too deep to be seen yet. 

Dorsalis Man us — Leaves the ulnar at the lower part 
of the arm, and passes to the back of the wrist. 

By removing the belly of the flexor sublimis, we ex- 
pose the deep-seated muscles. 

6. The Flexor Profundus Perforans — Arises, 
fleshy, from the smooth concavity on the inside of the 
ulna, betwixt the coronoid process and the olecranon; 
from the smooth flat surface of the ulna, betwixt its pos- 
terior and internal angles ; from the under part of the 
coronoid process, and from the forepart of the ulna be- 
low that process. It also arises from the inner half of 
the interosseous ligament. This muscle forms a thick 
mass, which descends along the forepart of the ulna, ad- 
hering to that bone as low as one-third of its length 
from its inferior extremity, and terminates in sending 
off four tendons. These tendons pass together under 
the annular ligament of the wrist, run through the slits 
in the tendons of the flexor sublimis, and are 

Inserted into the fore and upper part of the third or 
last phalanx of all the fingers. 

Situation. This muscle is concealed by the flexor sub- 
limis and flexor carpi ulnaris. Its tendons will be seen 
in dissecting the hand. 



MUSCLES OF THE FOREARM. 117 

Use. To bend the last joint of the fingers. 

7. Flexor Longus Pollicis Manus — Arises, by an 
acute fleshy beginning, from the upper and forepart of 
the radius, immediately below its tubercle, fleshy from 
the outer edge and anterior surface of that bone as low 
as two inches above its inferior extremity, and from the 
outer part of the interosseous ligament. It has also 
generally a tendinous origin from the internal condyle of 
the os humeri. This origin forms a distinct fleshy slip, 
which is joined to the inner and upper part of the portion 
of the muscle arising from the radius. The fibres pass 
obliquely, into a tendon on the anterior surface of the 
muscle. The tendon passes under the annular ligament 
of the wrist, runs between the tw T o heads of the short 
flexor of the thumb, and between the two sesamoid bones, 
and is 

Inserted into the base of the extreme phalanx of the 
thumb. 

Situation. This muscle lies by the side of the flexor 
profundus ; the portion w 7 hich arises from the inner con- 
dyle passes over the belly of the flexor profundus, and 
under the flexor sublimis. Its tendon will be seen in 
dissecting the short muscles of the thumb. 

Use. To bend the last joint of the thumb. 

On separating the lower part of the two last described 
muscles, we expose a small square muscle, passing trans- 
versely just above the wrist. 

8. The Pronator Quadratus — Arises, broad, ten- 
dinous, and fleshy, from the inner edge of the ulna, ex- 
tending from the lower extremity of the bone two inches 
up its edge. The fibres run transversely, adhere to the 
interosseous ligament, and are 

Inserted into the lower and anterior part of the radius. 1 
Situation. This muscle lies close to the bones, covered 
by the flexor longus pollicis and flexor digitorum sub- 
limis. 



1 This muscle, if carefully examined, will be seen to consist of two 
sets of fibres, having different directions- -first pointed out, I believe, 
by Dr. J. Rhea Barton, of this city. 



118 



PRACTICAL ANATOMY. 



Use. To turn the radius, together with the hand, in- 
ward. 

Fig. 38. 
A Front View of some or the Muscles or the Forearm. 




1. Pronator Radii Teres. 

2. Pronator Quadratus. 

3. Supinator Radii Brevis. 



Muscles situated on the Outer and Back Part of the Fore- 
arm, and arising from the Outer Condyle of the Os 
Humeri. 

These muscles are eleven in number, and may be di- 
vided into two classes : 1. The superficial; and 2. The 
deep seated. 

The Superficial. 

The muscles which arise from the outer condyle are 
much more distinct in their origins than those which 
arise from the inner condyle. Several of them arise a 
considerable way up the os humeri; but there is here 
also a common tendinous origin from which the extensor 
carpi radialis brevior, extensor digitorum communis, and 



MUSCLES OF THE FOREARM. 119 

extensor carpi radialis longior proceed, so that these 
muscles are intimately connected. 

1. Supinator Radii Longus — Arises, tendinous and 
fleshy, from the external ridge of the os humeri which 
leads to the outer condyle. It begins to arise nearly as 
far up as the middle of the bone, and ceases to adhere 
about two inches above the condyle. It forms a thick 
fleshy belly, which passes over the side of the elbow- 
joint, becomes smaller, and terminates above the middle 
of the forearm in a flat tendon. The tendon becomes 
gradually rounder, and is 

Inserted into a rough surface on the outer side of the 
inferior extremity of the radius. 

Situation. This muscle is situated immediately under 
the integuments along the outer edge of the arm and 
forearm. Its origin lies betwixt the brachialis internus 
and short head of the triceps extensor cubiti. Its in- 
sertion is crossed by the extensors of the thumb. 

Use. To roll the radius outward, and turn the palm 
of the hand upward; also to bend the forearm on the 
humerus. 

2. The Extensor Carpi Radialis Longior — 
Arises, tendinous and fleshy, from the external ridge of 
the os humeri, beginning immediately below the origin 
of the supinator longus, and continuing to arise as far 
as the upper part of the outer condyle. It forms a thick 
short belly, which passes over the side of the elbow- 
joint, and terminates above the middle of the radius in 
a flat tendon. The tendon runs along the radius, and, 
becoming rounder, passes through a groove in the back 
part of the inferior extremity of that bone, to be 

Inserted into the posterior and upper part of the met- 
acarpal bone of the forefinger. 

Situation. The belly lies under the supinator longus, 
but part of it projects behind that muscle. The tendon 
descends behind that of the supinator, and passes under 
the extensors of the thumb and annular ligament of the 
wrist, to arrive at the place of its insertion. 

Use. To extend the wrist and move the hand back- 
ward, and to assist in bending the forearm. 



120 PRACTICAL ANATOMY. 

3. The Extensor Carpi Radialis Brevior — - 
Arises, tendinous, from the under and back part of the 
external lateral ligament of the elbow-joint. Its thick 
belly runs along the outside of the radius, and termin- 
ates in a tendon, which passes through the same groove 
in the radius as the extensor radialis longior, and under 
the annular ligament. 

Inserted, by a round tendon, into the upper and back 
part of the metacarpal bone that supports the middle 
finger. 

Situation. This muscle lies partly under the extensor 
radialis longior ; but it also projects behind it. It passes 
under the extensors of the thumb and the indicator. 

Use. To extend the hand. 

4. The Extensor Digitorum Communis — Arises, 
tendinous, from the under part of the external condyle 
of the os humeri ; fleshy, from the intermuscular fascia, 
and from the inner surface of the fascia. It descends 
along the back part of the forearm, and adheres to the 
ulna where it passes over it. The fleshy belly termin- 
ates in four flat tendons, which pass under the annular 
ligament in a depression on the back part of the radius, 
and are 

Inserted into the posterior part of all the bones of 
the fingers by a tendinous expansion. 

Situation. It arises and descends betwixt the extensor 
radialis brevior and the extensor carpi ulnaris, and is 
situated immediately under the integuments. The ten- 
dons are connected on the back of the metacarpal bone 
by cross slips. The inner part of this muscle is some- 
times described as a separate muscle, and is called Ex- 
tensor Proprius Minimi Digiti, vel Auricularis. 
It passes through a separate depression of the radius 
and a particular ring of the annular ligament. 

Use. To extend all the joints of the fingers. 

The posterior surface of each finger is covered with a 
tendinous expansion, which is formed by the tendons of 
the common extensor, of the lumbricales, and interossei. 
This tendinous expansion terminates in the third or ex- 
treme phalanx. 



MUSCLES OF THE FOREAKM. 



121 



5. The Extexsor Carpi Ulnaris — Arises, tendin- 
ous, from the upper part of the external condyle ; fleshy, 
from the intermuscular fascia and inside of the fascia. 



Fig. 39. 
The Superficial Layer of Muscles ox the Back and Forearm. 



The Lower Part of the Biceps. 

Part of the Brachialis Interims. 

The Insertion of the Triceps into the 
Olecranon. 

The Supinator Radii Longus. 

The Extensor Carpi Radialis Longior. 

The Extensor Carpi Radialis Brevior. 

The Tendinous Insertion of these two 
Muscles 

The Extensor Communis Digitorum. 

The Extensor Minimi Digiti. 

The Extensor Carpi Ulnaris. 

The Anconeus. 

Part of the Flexor Carpi Ulnaris. 

The Extensor Minor Pollicis and the 
Ossis Metacarpi Pollicis lying to- 
gether. 

The Extensor Major Pollicis; its ten- 
don is seen crossing the tendons of 
the two radio-carpal extensors. 

The Posterior Annular Ligament. 
The tendons of the Extensor Com- 
munis are seen upon the back of 
the hand, and also their mode of 
distribution on the backs of the 
fingers. 



9. 
10. 
11. 
12. 
13. 



14. 



15. 




It crosses toward the ulna, and arises, fleshy, from the 
back part of that bone. It terminates in a strong ten- 
don, which passes through a groove in the back part of 
the lower end of the ulna, under the annular ligament, 
and is 

Inserted into the posterior and upper part of the 
metacarpal bone of the little finger. 

Situation. This muscle is entirely superficial. It 



122 PRACTICAL ANATOMY. 

arises from the condyle betwixt the extensor digitorum 
communis and anconeus. 

Use. To extend the wrist, and bring the hand back- 
ward ; but chiefly to bend the hand laterally toward 
the ulna, as it will appear by pulling its tendon in the 
dissected subject. 

6. The Anconeus is a small triangular muscle, situ- 
ated at the outer side of the olecranon, immediately 
under the integuments. 

It arises, tendinous, from the posterior and lower part 
of the external condyle of the os humeri ; forms a thick 
triangular fleshy mass, adhering to the capsular ligament 
of the elbow-joint, and is 

Inserted into the concave surface on the outside of 
the olecranon, and into the posterior edge of the ulna. 

Situation. This muscle lies betwixt the upper part 
of the extensor carpi ulnaris and the olecranon. It is 
partly covered by the tendon of the triceps extensor 
cubiti, and is enveloped in a fascia sent off from that 
tendon. 

Use. To assist in extending the forearm. 

By removing the superficial muscles, we expose 

The Deep Seated. 

7. The Supinator Radii Brevis — Arises, tendinous, 
from the lower part of the external condyle of the os 
humeri; tendinous and fleshy, from the ridge running 
down from the coronoid process along the outer surface 
of the ulna. The fibres adhere firmly to the ligament 
that joins these two bones, pass outward round the 
upper part of the radius, and are 

Inserted into the upper and outer edge of the tubercle 
of the radius, and into an oblique ridge extending from 
the tubercle downward and outward to the insertion of 
the pronator teres. 

Situation. This muscle nearly surrounds the upper and 
outer part of the radius. It is concealed at the outer 
edge of the arm by the supinator longus and extensores 
carpi radiales; behind, by the extensor digitorum com- 



MUSCLES OF THE FOREARM. 123 

munis, extensor carpi ulnaris, and anconeus; before, by 
the brachialis internus, and by the tendon of the biceps 
flexor cubiti, close to which tendon this muscle is in- 
serted. 

Use. To roll the radius outward, and bring the hand 
supine. 

On the back part of the forearm we meet with three 
muscles going to the thumb, and one to the forefinger. 

8. The Extensor Ossis Metacarpi Pollicis — 
Arises, fleshy, from the middle and posterior part of 
the ulna, immediately below the termination of the an- 
coneus, from the interosseous ligament, and from the 
posterior surface of the radius below the insertion of the 
supinator radii brevis. The fleshy fibres terminate in a 
tendon which passes through a groove in the outer edge 
of the lower extremity of the radius. 

Inserted, generally by two tendons, into the os trape- 
zium, and into the upper and back part of the metacarpal 
bone of the thumb. 

Use. To extend the metacarpal bone of the thumb 
outwardly. 

9. The Extensor Primi Internodii Pollicis 
Manus — Arises, fleshy, from the back part of the ulna 
below its middle, from the interosseous ligament and 
radius. It runs along the lower edge of the extensor 
ossis metacarpi, and forms a tendon, which passes 
through the same groove as the tendon of that muscle, 
and is 

Inserted into the posterior part of the first bone of 
the thumb. Part of the tendon is also continued into 
the base of the second or extreme phalanx. 

Use. To extend the first phalanx of the thumb ob- 
liquely outward. 

10. The Extensor Secundi Internodii Pollicis 
Manus — Arises, tendinous and fleshy, from the posterior 
surface of the ulna above its middle, and from the inter- 
osseous ligament. Its belly partly covers the origins of 
the two other extensors of the thumb, and terminates in 
a tendon, which runs through a distinct groove in the 
back part of the radius, and is 



124 PRACTICAL ANATOMY. 

, Inserted into the posterior and upper part of the second 
or extreme phalanx of the thumb. 

Use. To extend the last joint of the thumb obliquely 
backward. 

Situation of the extensors of the thumb. — The origins 
of these muscles are concealed by the extensor digitorum 
communis and extensor carpi ulnaris. The tendon of 
the extensor secundi internodii is at a considerable dis- 
tance from the tendons of the two other extensors; so 
that, in the intermediate space, we see the terminations 
of the tendons of the extensores carpi radiales. They 
invest the back part of the thumb with a fascia. 

11. The Indicator — Arises, by an acute fleshy be- 
ginning, from the middle of the back part of the ulna, 
and from the interosseous ligament. Its tendon passes 
through the same sheath of the annular ligament with 
the extensor digitorum communis, and is 

Inserted into the posterior part of the forefinger with 
the tendon of the common extensor. 

Situation. It arises nearer to the inner edge of the 
arm than the extensor secundi internodii pollicis. It is 
concealed by the extensor digitorum communis and ex- 
tensor carpi ulnaris. The tendon passes under that of 
the common extensor. 

Use. To assist in extending the forefinger. 

Posterior Interossea Artery, resting on the 
posterior part of the interosseous ligament, supplying 
muscles, and anastomosing with carpal arteries on the 
back of the wrist. 

Dissection of the Palm of the Hand. 

The tendons which pass over the bones of the carpus 
into the palm of the hand are firmly bound down by the 
annular ligament of the wrist. They are invested and 
connected by cellular membrane, which forms sheaths, 
and secretes synovia to facilitate their motions. 

On removing the integuments from the palm of the 
hand w T e meet with a strong fascia. It arises from the 
tendon of the palmaris longus and from the annular liga- 



MUSCLES OF THE PALM OF THE HAND. 125 

ment of the wrist, expands over all the palm of the hand, 
and is fixed to the roots of the fingers, splitting to trans- 
mit their tendons. These forks or splits are connected 
by transverse fibres. This is the Fascia or Aponeurosis 
Palmaris. It is triangular. Where it arises from the 
wrist it is narrow, and does not cover the base of the 
metacarpal bones of the little and forefinger. As it runs 
over the hand it becomes broader, and is fixed by a bi- 
furcated extremity in the lower end of each of the meta- 
carpal bones of the four fingers. The palmar fascia is 
strong and thick, and conceals and supports the muscles 
of the hand. Its deep surface is connected to the inter- 
osseous fascia by two membranous prolongations. It 
exerts great influence on deep-seated abscesses of this 
part. 

There is a small thin cutaneous muscle situated be- 
tween the wrist and the little finger. 

The Palmaris Brevis — Arises from the annular 
ligament of the wrist, and from the inner edge of the 
fascia palmaris. 

Inserted, by small scattered fibres, into the skin and 
fat which cover the short muscles of the little finger and 
inner edge of the hand. 

Use. To assist in contracting the palm of the hand. 

The Fascia Palmaris may now be removed. Under 
it will be seen the arcus sublimis and the digital nerves 
from the ulnar and median presently to be described, 
and the four tendons of the flexor sublimis perforatus. 
They are seen coming from beneath the annular liga- 
ment of the wrist, and diverging as they pass toward 
their respective fingers. Each tendon splits at the ex- 
tremity of the first phalanx for the passage of the ten- 
don of the flexor profundus perforatus, and inserted 
into the base of the second phalanx. 

Under the flexor sublimis are the four tendons of the 
flexor profundus perforans, which pass through the slits 
in the tendons of the former, and are inserted into the 
bases of the third phalanges of the fingers. 

The Lumbricales are four small muscles, which arise, 
tendinous and fleshy, from the outer side of the tendons 



126 PRACTICAL ANATOMY. 

of the flexor profundus perforans, soon after those ten- 
dons have passed the ligamentum carpi annulare. Each 
of these muscles has a small belly, which terminates in 
a tendon. The tendon runs along the outer edge of the 
finger, and is 

Inserted into the tendinous expansion which covers 
the hack part of the phalanges of the fingers about the 
middle of the first joint. 

Use. To bend the first phalanges of the fingers, the 
flexor profundus being previously in action, to afford 
them a fixed point. 

The short muscles of the thumb and forefinger are five 
in number. 

1. The Abductor Pollicis Manus — Arises, by a 
broad tendinous and fleshy origin, from the anterior 
surface of the annular ligament of the wrist, and from 
the os naviculare and os trapezium. 

Inserted, tendinous, into the outer side of the root of 
the first phalanx of the thumb, and into the tendinous 
membrane which covers the back part of all the pha- 
langes. 

Situation. This muscle is situated immediately under 
the integuments, and is the outermost portion of the 
muscular mass forming the ball of the thumb. 

Use. To draw the thumb from the fingers. 

2. The Flexor Ossis Metacarpi Pollicis, or Oppo- 
nens Pollicis — Arises, broad and fleshy, from the annular 
ligament of the wrist, and from the os naviculare and os 
trapezium. 

Inserted, tendinous and fleshy, into the anterior and 
low^er part of the metacarpal bone of the thumb. 

Situation. It lies under the abductor pollicis, and is 
almost entirely concealed; but a few of its fibres are seen 
projecting beyond the edge of that muscle. 

Use. To bring the first bone of the thumb inward. 

3. The Flexor Brevis Pollicis Manus arises by 
two distinct heads. 

(1) The outer head arises from the inside of the annu- 
lar ligament; from the anterior surface of the os trape- 
zium and os trapezoides, and from the root of the meta- 
carpal bone of the forefinger. 



MUSCLES OF THE PALM OF THE HAND. 



127 



Inserted into the outer sesamoid bone, which is con- 
nected by a ligament to the root of the first phalanx of 

the thumb. 

Fie. 40. 




A Front View or the deep-seated Palmar Muscles. 



1. Pronator Quadratus. 

2. Opponens Pollicis. 

3. Its attachment to the Annular 

Ligament. 

4. Adductor Pollicis arising from 

the whole front of the second 
Metacarpal bone (Os Trape- 
zium and Os Magnum). 

5. Adductor Metacarpi Minimi 

Digiti, 

6. Its Origin from the Os Unci- 

forme. 



7. Os Pisiforme. 

8, 9, 10, 11, 12, 13, 14. Interos- 

sei Muscles. 

8. Prior Indicis. 

9. Posterior Indicis. 

10. Prior Medii. 

11. Posterior Medii. 

12. Prior Annularis. 

13. Posterior Annularis. 

14. Interosseous Digiti Auricula- 



128 PRACTICAL ANATOMY. 

(2) The inner head arises from the upper part of the 
os magnum and os unciforme, and from the root of the 
metacarpal bone of the middle finger. 

Inserted into the inner sesamoid bone, which is con- 
nected by a ligament to the root of the first phalanx of 
the thumb. 

Situation. This muscle is in great part concealed by 
the abductor pollicis. Its inner origin is under the first 
umbricalis; its upper part is seen projecting, and be- 
tween its two portions we find the tendon of the flexor 
longus pollicis. 

Use. To bend the first joint of the thumb. 

4. The Adductor Pollicis Manus — Arises, fleshy, 
from almost the whole length of the metacarpal bone 
sustaining the middle finger. The fibres converge, and 
pass over the metacarpal bone of the forefinger, to be 

Inserted, tendinous, into the inner part of the root of 
the first phalanx of the thumb. 

Situation. The belly of this muscle is concealed, as it 
lies close to the bone under the tendons of the flexor pro- 
fundus and lumbricales. The tendon is seen where it is 
inserted into the thumb. 

Use. To pull the thumb toward the fingers. 

5. The Adductor Indicis Manus — Arises, tendin- 
ous and fleshy, from the os trapezium, and from the 
inner side of the metacarpal bone of the thumb. It forms 
a fleshy belly, runs over the side of the first joint of the 
forefinger, and is 

Inserted, by a short tendon, into the outer side of the 
root of the phalanx of the forefinger. 

Situation. This muscle is seen most distinctly on the 
back of the hand. It is there superficial, and is crossed 
by the tendon of the extensor secundi internodii pollicis. 
In the palm of the hand it is concealed by the muscles 
of the ball of the thumb. 

Use. To move the forefinger toward the thumb, or 
the thumb toward the forefinger. 

The insertion of the flexor carpi radialis is exposed 
by removing the muscles of the thumb. 

The short muscles of the little finger are three in 
number. 






MUSCLES OF THE PALM OF THE HAND. 129 

1. The Abductor Minimi Digiti Manus — Arises, 
fleshy, from the os pisiforme, and adjacent part of the 
annular ligament of the wrist. Its fibres extend along 
the metacarpal bone of the little finger. 

Inserted, tendinous, into the inner side of the first 
phalanx, and into the tendinous expansion which covers 
the back part of the little finger. 

Situation. The belly of this muscle is superficial. It 
is only covered by the straggling fibres of the palmaris 
brevis. 

Use. To draw the little finger from the rest. 

2. The Flexor Parvus Minimi Digiti — Arises, 
fleshy, from the outer side of the os unciforme, and from 
the annular ligament of the wrist, where it is affixed to 
that bone. 

Inserted, by a roundish tendon, into the base of the 
first phalanx of the little finger. 

Situation. This muscle is also covered by the fibres 
of the palmaris brevis. It lies on the inner side of the 
abductor minimi digiti, and its tendon is connected to 
the tendon of that muscle. 

Use. To bend the little finger, and bring it toward the 
other fingers. 

3. Adductor Metacarpi Minimi Digiti Manus — 
Arises, fleshy, from the os unciforme and adjacent part 
of the annular ligament of the wrist. It forms a thick 
mass, which is 

Inserted, tendinous, into the forepart of the metacar- 
pal bone of the little finger, nearly its whole length. 

Situation. It is concealed by the bellies of the ab- 
ductor and flexor brevis minimi digiti. 

Use. L To bend and bring the metacarpal bone of the 
little finger toward the rest. 

The Interossei are small muscles situated between 
the metacarpal bones, and extending from the bones of 
the carpus to the fingers. They are exposed by re- 
moving the other muscles of the thumb and fingers. 

The Interossei Interni are seen in the palm of the 
hand, and are four in number. They arise, tendinous 

1 



130 PRACTICAL ANATOMY. 

and fleshy, from the base and sides of the metacarpal 
bones, and are inserted into the side of the first phalanx 
of the fingers, and into the tendinous expansion which 
covers the posterior surface of all the phalanges. The 
Arcus profundus runs across the metacarpal bones and 
these muscles. 

1. The First, named Prior Indicis, arises from the 
outer part of the metacarpal bone of the forefinger ; and 
is inserted into the outer side of the first phalanx of 
that finger. Use. To draw the forefinger toward the 
thumb. 

2. The Second, named Posterior Indicis, arises from 
the root and inner side of the metacarpal bone of the 
forefinger; and is inserted into the inner side of the first 
phalanx of the forefinger. Use. To draw that finger 
outward. 

3. The Third, named Prior Annularis, arises from the 
root and outer side of the metacarpal bone of the ring- 
finger ; and is inserted into the outer side of the first 
phalanx of the same finger. Use. To pull the ring- 
finger toward the thumb. 

4. The Fourth, named Interosseus Auricularis, arises 
from the root and outer side of the metacarpal bone of 
the little finger ; and is inserted into the outer side of 
the first phalanx of the little finger. Use. To draw the 
little finger outward. 

The internal interossei also assist in extending the 
fingers obliquely. 

The Interossei Externi, seu Bicipites, are three in 
number. They are larger than the internal, and are 
situated betwixt the metacarpal bones on the back of the 
hand. Each of these muscles arise, by a double head, 
from two metacarpal bones, and is inserted into the side 
of one of the fingers, and into the tendinous expansion 
which covers the posterior part of the phalanges. 

1. The First, named Prior Medii, arises from the roots 
of the metacarpal bones of the fore and middle fingers ; 
and is inserted into the outer side of the middle finger. 
Use. To draw the middle finger toward the thumb. 



ARTERIES OF THE SUPERIOR EXTREMITY. 131 

2. The Second, named Posterior Medii, arises from 
the roots of the metacarpal bones of the middle and ring- 
fingers; and is inserted into the inner side of the middle 
finger. Use. To draw the middle finger toward the ring- 
finger. 

3. The Third, named Posterior Annularis, arises from 
the roots of the metacarpal bones of the ring and little 
fingers; and is inserted into the inner side of the ring- 
finger. Use. To draw the ring-finger inward. The ex- 
ternal interossei also extend the fingers. 

Of the Vessels and Nerves of the Superior Extremity. 

Arteries. 

The subclavian and axillary arteries have been de- 
scribed. 

The Brachial Artery may be said to have its course 
along the inside of the arm. Having left the axilla, it 
runs along the inferior edge of the coraco-brachialis. 
Rather higher up than the middle of the os humeri, it 
crosses over the tendinous insertion of that muscle, being 
here situated between the belly of the biceps flexor cubiti 
and the superior fibres of the brachialis externus. The 
artery then passes behind the inner edge of the biceps 
flexor cubiti, descending betwixt that muscle and the 
fibres of the brachialis internus. In dissecting this ves- 
sel, we find it invested by a fascia or sheath, formed by 
cellular membrane and some tendinous fibres. On dis- 
secting this fascia, we find, close to the margin of the 
coraco-brachialis and biceps flexor cubiti, the great 
median nerve; under it the brachial artery, and, more 
superficially seated, the venae comites and the vena 
basilica. As the artery approaches the lower extremity 
of the os humeri, it inclines forward toward the fold of 
the arm, and dives beneath the aponeurosis which arises 
from the inside of the tendon of the biceps flexor cubiti. 
Its situation at the fold of the arm has been described. 



132 



PRACTICAL ANATOMY. 



Branches of the Brachial Artery. 

1. A. Profunda Humeri Superior, or Muscularis 
Superior, is sent off from the inner side of the brachial 
artery, immediately where it has left the fold of the arm- 
pit. It passes downward and backward round the os 
humeri, and is accompanied by the musculo-spiral nerve. 

Fig. 41. 
A View of the Axillary and Brachial Arteries. 




1. Axillary Artery, which ends 
at 2 in the Brachial. 

2, 3. Brachial Artery. 

4, 5, 6, 7. External Thoracic Arte- 
ries. 

8. Subscapular Artery. 

9. Its Dorsal Branch. 

10. Posterior Circumflex. 

11. Anterior Circumflex. 

12. Profunda Superior. 

13. Profunda Inferior vel Minor. 

14. Anastomotic Artery. 

15. Subscapularis Muscle. 

16. Teres Major. 

17. Biceps Flexor Cubiti. 

18. Triceps. 



It passes betwixt the brachialis externus and short head 
of the triceps extensor cubiti. Here it lies deep among 
the muscles, and divides into two branches. One accom- 
panying the nerve spreads its ramification over the outer 
condyle, and anastomoses with the arteries below the 



ARTERIES OF THE SUPERIOR EXTREMITY. 133 

elbow. The other branch is distributed along the inside 
of the arm and about the inner condyle. 

2. A. Profunda Humeri Inferior is smaller than 
the last, and is sent off from the brachial artery about 
two inches lower down. It descends among the muscles 
on the inside of the arm, and is lost about the inner 
condyle. 

3. The anastomosing or collateral arteries are as 
follows : 

(1) The Ramus Anastomoticus Major passes from the 
inside of the brachial artery, about two or three inches 
above the inner condyle. It is distributed about the 
condyle, and its principal branch accompanies the ulnar 
nerve in the groove betwixt the olecranon and inner con- 
dyle, to anastomose with the recurrent branches of the 
arteries of the forearm. 

(2) Muscular Branches. 

The Brachial Artery, where it lies deep under the 
aponeurosis of the biceps, divides into three branches. 
1. The radial. 2. The ulnar; and 3. The interosseous 
artery. The two last generally come off by one trunk, 
which subdivides. 

1. Arteria Radialis. The radial artery is smaller 
than the ulnar, and in its course more superficial. It 
leaves the ulnar artery, and inclines toward the radial 
and outer edge of the forearm. At first it lies betwixt 
the pronator teres and supinator longus. It then de- 
scends close along the inner edge of the supinator longus, 
betwixt the supinator longus and flexor carpi radialis, 
and is accompanied by the radial nerve. Reaching the 
lower extremity of that bone, it divides into two 
branches. 

(1) A. Superficialis Yolm is by much the smallest 
of the two branches. It passes into the muscular mass 
which forms the ball of the thumb, anastomosing with 
the superficial palmar arch. 

(2) The trunk of the radial artery crosses over the 
lower extremity of the radius to the back of the hand. 
It passes under the extensors of the thumb, and, arriv- 
ing at the space betwixt the bases of the metacarpal 



134 



PRACTICAL ANATOMY. 



bones of the thumb and forefinger, plunges into the palm 
of the hand. 

Fig. 42. 

Arteries of the Forearm and Hand. 




1. Brachial Artery. 

2. Profunda Minor. 

3. Bifurcation of the Brachial into the 
Radial and Ulnar. 

4. Radial. 

5. Recurrens Radialis. 

6. Anterior Carpal. 

7. Dorsalis Carpi. 

8. Superficialis Volse. 

9. Arcus Profundus. 

10. Magnus Pollicis. 

11. Artery of the Thumb. 

12. Radialis Indicis. 

13. Ulnar Artery. 

14. Recurrens Ulnaris. 

15. Anterior Interosseal. 

16. Cubitalis-manus Profunda, or Anasto- 
mosing Artery. 

17. Arcus Sublimis. 

18. Digital Arteries. 
19 19, 19. Digito-ulnar Arteries. 



The branches of the radial artery, in its course along 
the forearm, are the following: 

(1) The recurrent artery is sent off from the radial 
immediately after it leaves the ulnar artery, and is dis- 
tributed over the anterior part of the outer condyle, 
where it anastomoses with branches of the brachial ar- 
tery. 

(2) Muscular, to the muscles of the forearm. 

(3) A branch leaves the artery immediately after it 
has turned over the edge of the radius, and, ramifying 
on the back of the hand, is named Dorsalis Carpi. 

(4) Small vessels are sent off to the back part of the 
thumb, named A. Dorsales Pollicis. 



ARTERIES OF THE FOREARM AND HAND. 135 

Having reached the palm of the hand, the radial artery 
divides into two branches. 

(1) A. Pollicis, which sends two or three arteries along 
the anterior part of the thumb, and also often gives off a 
twig, the A. Radialis Indicis, which passes along the outer 
edge of the forefinger, and inosculates with a branch of 
the ulnar artery. 

(2) The trunk of the radial artery forms the Deep- 
seated Palmar Arch. From the root of the thumb, it 
passes across the metacarpal bones near their bases, and 
terminates at the metacarpal bone of the little finger, in- 
osculating with a branch of the ulnar artery. This arch 
lies deep, close to the bones. It supplies the interosseous 
muscles and deep-seated parts of the palm, and some of 
its branches pass betwixt the metacarpal bones to the 
back of the hand. 

2. Arteria Ulnaris. The ulnar artery is the largest 
branch of the brachial, and generally gives off the inter- 
osseous artery. It takes its course deep among the 
muscles on the inside of the forearm. It is seen passing 
under the pronator teres, flexor carpi radialis, palmaris 
longus, and flexor sublimis perforatus, but over the flexor 
profundus perforans. It descends in the connecting cel- 
lular membrane, between the flexor sublimis and pro- 
fundus; but above the middle of the forearm, it emerges 
from these muscles, and appears at the ulnar edge of the 
arm, betwixt the flexor sublimis and flexor carpi ulnaris. 
It passes over the annular ligament of the wrist, but is 
covered by the fascia which ties down the tendon of the 
flexor carpi ulnaris. It passes under the palmar aponeu- 
rosis, on the inside of the os pisiforme, reaches the base 
of the metacarpal bone of the little finger, and begins to 
form the Superficial Palmar Arch. This arch lies 
above the tendons of the flexor sublimis perforatus, im- 
mediately beneath the Palmar Aponeurosis. It crosses 
the metacarpal bones betwixt their bases and the middle 
of their bodies. It begins at the root of the little finger, 
and terminates at the root of the thumb, in inosculations 
with the branches of the radial artery. The convex side 
of the arch is turned toward the fingers, and sends off 
five branches. 



136 PRACTICAL ANATOMY. 

(1) A branch to the muscles and inner edge of the 
little finger. 

(2) Ramus digitalis primus, or the first digital artery, 
which runs along the space betwixt the two last meta- 
carpal bones, and bifurcates into two branches, one to 
the outside of the little finger, and the other to the inner 
side of the ring-finger. 

(3) The second digital artery, which bifurcates in a 
similar manner, and supplies the outer edge of the ring- 
finger, and the inner -side of the middle finger. 

(4) The third digital artery, which is distributed to 
the outer edge of the middle finger, and to the inner side 
of the forefinger. 

(5) The ramus Pollicis ulnaris is the last branch of 
the ulnar artery, and is sent to the muscles of the thumb. 

From the concavity of the arch are sent off* the inter- 
osseous arteries of the palm, small twigs which supply 
the deep-seated parts, and perforate betwixt the meta- 
carpal bones to the back of the hand. 

The branches of the ulnar artery, in its course along 
the forearm and wrist, are the following: 

(1) The Recurrent Arteries are sent off" from the 
ulnar artery immediately below the elbow. These arte- 
ries inosculate with branches of the brachial. 

(2) Twigs to the muscles of the forearm. 

(3) A. Dorsalis Carpi is sent off from the ulnar artery 
a little above the wrist to the back of the hand. 

(4) A. Palmaris Profunda is sent off from the ulnar 
artery, on the inside of the os pisiforme. It passes into 
the flesh at the root of the little finger, and inosculates 
w r ith the termination of the deep-seated palmar arch of 
the radial artery. 

3. Arteria Interossea (or Interossea Communis). 
This artery is generally sent off from the ulnar. It im- 
mediately divides into two branches. 

(1) The external or posterior interosseous artery is the 
smallest branch. It passes through the upper part of the 
interosseous ligament, to supply the muscles on the pos- 
terior part of the forearm. It sends off the A. Recur- 
rens Interossea, which ramifies on the middle of the back 
part of the elbow-joint. 



NERVES OF THE SUPERIOR EXTREMITY. 137 

(2) The internal or anterior interosseous artery de- 
scends close upon the middle of the interosseous liga- 
ment, giving twigs to the adjacent muscles. At the 
upper edge of the pronator quadratus, it perforates the 
membrane to the back part of the arm, and spreads its 
extreme branches on the wrist and back of the hand. 

Veins, 

The cutaneous veins have been already described. 

The brachial artery is accompanied by two veins, named 
Vense Comites, or Satellites. These receive branches 
corresponding to the ramifications of the artery. 

Nerves. 

In the dissection of the axilla, we demonstrated the 
great axillary plexus, and traced its two first branches, 
the external scapular and circumflex nerves. See Fig. 20. 
The distribution of the five remaining branches of the 
plexus must now be described. 

(3) The External Cutaneous Nerve (Musculo- 
cutaneus, or Perforans Casserii) is the third branch of 
the axillary plexus. It passes through the belly of the 
coraco-brachialis muscle. It continues its course betwixt 
the Biceps flexor cubiti and the Brachialis internus. It 
gives twigs to these muscles, and appears as a superficial 
nerve on the edge of the supinator longus. It runs over 
the outer condyle, and is distributed to the integuments 
on the outside of the forearm and back of the hand. 

(4) The Median Nerve accompanies the brachial 
artery to the bend of the elbow. In its passage down 
the arm, it lies before that vessel, but at the elbow is 
situated on its inside. It gives oft' no branches until it 
has sunk under the aponeurotic expansion of the biceps 
flexor. Here it distributes many nerves to the muscles 
of the forearm, to the pronator teres, flexor carpi radi- 
alis, the flexors of the thumb and fingers, and the pro- 
nator quadratus. The trunk of the nerve perforates the 
pronator teres, passes betwixt the flexor digitorum sub- 

1* 



138 PRACTICAL ANATOMY. 

limis and flexor profundus, and continues its course be- 
twixt these muscles down to the wrist. Near the wrist 
it becomes more superficial, lying among the tendons of 
the flexors, and before it descends under the annular 
ligament, sends a superficial branch to the integuments 
and short muscles of the thumb. The nerve itself passes 
with the flexor tendons of the fingers under the annular 
ligament of the wrist, and appears on their outside, near 
the root of the thumb. It ramifies superficially in the 
hand, sending off four branches, which supply the thumb 
and all the fingers except the little finger and the ulnar 
side of the ring-finger. 

(5) The Ulnar Nerve descends along the inside of 
the arm. It is at first situated immediately under the 
integuments, but below the middle of the arm is tied 
down by the intermuscular fascia. The nerve then runs 
between the inner condyle and the olecranon. After 
passing the condyle, it continues its course betwixt the 
two heads of the flexor carpi ulnaris, till it reaches the 
ulnar artery. It then accompanies the ulnar artery, 
lying on its inside, and running along the forearm be- 
twixt the flexor ulnaris and flexor digitorum sublimis. 
It sends twigs to the neighboring muscles, and, when 
arrived near the wrist, divides into two branches. 1. The 
Smaller Branch, called Ramus posticus, passes under the 
tendon of the flexor carpi ulnaris, and over the lower end 
of the ulna, to be distributed to the back of the hand, 
and of the little and ring-fingers. 2. The continued 
trunk of the nerve passes, on the inside of the ulnar 
artery, over the annular ligament of the wrist. It passes 
under the palmar aponeurosis, and divides into three 
principal branches. The first supplies the integuments 
and muscles on the ulnar edge of the hand, and the 
inner side of the little finger. The second is distributed 
to the outer side of the little finger and inner side of 
the ring-finger. The third branch accompanies the deep- 
seated palmar arch, and terminates in the short muscles 
of the thumb and forefinger, communicating with the 
median nerve. 

(6) The Musculo-Spiral Nerve (Radial of some 



NERVES OF THE SUPERIOR EXTREMITY. 139 

anatomists) passes from the axilla behind the os humeri, 
making a spiral turn round the bone to reach the outside 
of the arm. It first descends between the brachialis 
externus and short head of the Triceps extensor eubiti, 
accompanying the arteria profunda humeri superior, and 
passing deep into the flesh of the arm. Before it makes 
this turn, it gives branches to the muscles, also a cuta- 
neous branch, which descends on the inside of the arm. 
From the back part of the arm the great trunk of the 
nerve is reflected spirally forward. It is seen emerging 
betwixt the supinator longus and brachialis internus, 
seated deep and close to the bone. It descends betwixt 
these muscles, keeping close to the edge of the supinator 
longus. Immediately after passing the fold of the arm, 
it sends off a nerve, which descends, superficial, upon the 
radial edge of the forearm, as far as the wrist; and, at, 
this point, the trunk of the muscular nerve divides itself 
into two branches. The first, a large branch, perforates 
the supinator brevis, and supplies the extensor muscles 
of the hand and fingers. The second branch accom- 
panies the supinator longus down the forearm, and near 
the wrist turns under the tendon of that muscle, over 
the edge of the radius. It then divides into several 
branches which ramify on the back of the wrist, thumb, 
and forefinger. 

(7) The Internal Cutaneous Nerve descends, su- 
perficial, along the inside of the arm and forearm. It 
was described among the cutaneous nerves of the arm. 



140 



PRACTICAL ANATOMY. 



CHAPTER X. 

DISSECTION OF THE ABDOMEN. 

Muscles of the Abdomen, and the Parts connected with 
them in Dissection. 



Before commencing its dissection, study what are 
called its regions. To mark them out, drop a perpen- 
dicular from the anterior inferior spinous processes 
through the cartilages of the ribs. Then cross these 
two lines by two others drawn the upper one through 
»the points where the first two touched the cartilages of 
the ribs, and the second from one anterior superior 

Fig. 43. 




The Abdominal Regions. 



1, 1. Hypochondriac Regions. 

2. Epigastric Region. 
3, 3 Lumbar Regions 



4. Umbilical Region. 
5, 5. Iliac Regions. 

6. Hypogastric Region. 



spinous process of the ilium to the other. These lines 
will define nine regions. Three in the centre, which, 



MUSCLES OF THE ABDOMEN. 141 

enumerated from above downward, are the Epigastric, 
Umbilical, and Hypogastric. Three on either side, 
which from above downward are the Hypochondriac, 
Lumbar, and Iliac Regions. 

The muscles are ten in number, five on each side. 

An incision should be made through the integuments, 
from the sternum to the os pubis ; and this should be 
crossed by another passing from the lower end of the 
sternum obliquely upward toward the axilla; dissect off 
the layers in order and this will expose — 

In the superficial fascia of the abdomen an artery, 
accompanied by its veins, the Superficial Epigastric, 
or Arteria ad cutem abdominis. 

1. The Obliquus Descendens Externus. — Origin. 
By eight triangular fleshy slips from the lower edges 
and external surfaces of the eight inferior ribs, at a, 
little distance from their cartilages ; the five superior 
slips meet on the ribs an equal number of the digitations 
of the serratus major anticus, and the three inferior are 
connected with the attachments which the latissimus 
dorsi has to the rib. To gain a complete view of this 
muscle, the neighboring portions of the pectoralis major, 
serratus anticus, and latissimus dorsi should be dissected 
with it. 

The muscular fibres proceed obliquely downward and 
forward, and about the middle of the side of the belly 
terminate abruptly in a thin broad tendon, which is con- 
tinued in the same direction over all the forepart of the 
belly. Here it covers the anterior surface of the rectus 
abdominis ; it is very thin at the upper part, where the 
rectus lies on the cartilages of the ribs, and is often re- 
moved by the beginner, unless he is very cautious. 

Insertion. Tendinous and fleshy, into two anterior 
thirds of the outer edge of the crista of the os ilium, 
from the anterior superior spine of which, for it extends 
to the os pubis, forming Poupart's ligament, into the 
ensiform cartilage, and into the whole length of the 
linea alba. 

Use. To draw down the ribs in expiration, to bend 
the trunk forward when both muscles act, or to bend it 



142 PRACTICAL ANATOMY. 

obliquely to one side when one of them acts singly ; to 
raise the pelvis obliquely when the ribs are fixed ; to 
compress the abdominal viscera, to thrust the diaphragm 
upward, to assist in the expulsion of the urine and feces, 
and of the foetus. 

In the course of the dissection of this single muscle, 
the following points must be attended to : 

The Linea Alba, a white line running along the 
middle of the abdomen, from the cartilago ensiformis to 
the os pubis ; formed by the tendinous fibres of the two 
obliqui and the transversalis muscles, interlaced with 
those of the same muscles on the opposite side; it is half 
an inch broad at the navel; and decreases gradually 
both above and below that part; but particularly in the 
latter situation, where it is reduced at last to a mere 
line. 

Linea Semilunaris, a semicircular white line run- 
ning from the os pubis obliquely upward over the side of 
the abdomen, at the distance of about four inches from 
the linea alba; formed by the tendons of the two ob- 
lique and transverse muscles uniting at the edge of the 
rectus, before they separate to form the sheath for that 
muscle. 

Linea Transversa, three or four white lines, cross- 
ing from the linea semilunaris to the linea alba ; formed 
by the tendinous intersections of the recti shining 
through the strong sheath which covers them. These 
are not evident in all subjects in this stage of the dis- 
section. 

Umbilicus, or Navel. This which, before the integu- 
ments were removed, was a depression, appears now a 
prominence; it consists of condensed cellular membrane. 

Annulus Abdominalis, or Ring, an oblique slit or 
opening just above the angle of the pubis ; formed by 
the tendon of the external oblique, divided into two por- 
tions called the pillars or columns of the ring, of which 
one (the superior or internal) is attached to the sym- 
physis, and the other (the inferior or external) to the 
tuberosity of the pubis; and allowing a passage to the 
spermatic cord in the n ale, and the ligamentum teres of 



MUSCLES OP THE ABDOMEN. 



143 




Dissection of some of the Parts concerned in Femoral and 
Inguinal Hernia. 

1. Tendon of the External Oblique Muscle. 

2. Tendon of the Internal Oblique, the first-named muscle being 

dissected off. 

3. Cribriform Fascia. 

4. Vena Saphena. 

5. External Abdominal Ring and Spermatic Cord. 

6. Poupart's Ligament. 



144 PRACTICAL ANATOMY. 

the uterus in the female. This slit is triangular; the 
pubis is the base, the two columns are the two sides of 
the triangle. From the margins of the pillars a thin 
fascia is derived which passes down upon the cord (the 
Intercolumnar or Spermatic Fascia). It forms a 
coating for an inguinal hernia. The apex has a rounded 
figure in consequence of some transverse fibres, which 
connect the two columns where they first separate; and 
it points obliquely upw T ard and outward. It belongs to 
the external oblique alone, there being no such opening, 
either in the internal oblique, or the transversalis ; it is 
much smaller in the female than in the male. 

Ligamentum Poupartii, a strong ligament, stretch- 
ing from the anterior superior spinous process of the os 
ilium, to be fixed to the spine of the os pubis. This in 
truth is merely the lower edge of .the tendon of the ob- 
liquus externus abdominis, extended from the anterior 
superior spinous process of the ilium .to the angle of the 
pubis. It covers the femoral vessels and nerves, and 
certain muscles, and has lately been often described un- 
de? the name of the Crural Arch. 

Dissect off the serrated origin of the external oblique 
from the ribs and from the spine of the os ilium, and de- 
tach it from the obliquus internus, which lies below it, 
and which is connected to it by loose cellular substance, 
and by small vessels. Continue to separate the two 
muscles till you find their tendons firmly attached, i.e. 
a little way beyond the linea semilunaris. Separate the 
tendon from Poupart's ligament to within half an inch 
of the abdominal ring. 

2. Obliquus Ascendbns Internus — Arises by short 
tendinous fibres, which soon become fleshy, from the 
whole length of the spine of the os ilium, and from the 
fascia lumborum; also fleshy from the upper part of 
Poupart's ligament at the part next to the os ilium. 

The fibres run in a radiated direction ; those which 
originate from the back part of the os ilium run ob- 
liquely upward ; those from the forepart of the ilium 
pass more transversely; and from Poupart's ligament 
the fibres descend. The fleshy belly is continued rather 



MUSCLES OF THE TRUNK. 

Fio; 45, 



145 




The Muscles of the Anterior Aspect of the Trunk; on the 
Left Side the Superficial Layer is seen, and on the Right 
the Deeper Layer. 



10. 

11. 
12. 
13. 



The Great Pectoral Muscle. 

The Deltoid Muscle. 

The Anterior Border of the Latissimus Muscle. 

The Indigitations of the Great Serratus Muscle. 

The Right Subclavian Muscle. 

The Small Pectoral Muscle. 

The Coraco-Brachialis Muscle. 

The Upper Part of the Biceps Muscle, showing its two heads. 

The Coracoid Process of the Scapula. 

The Great Serratus Muscle of the Right Side, 

The External Intercostal Muscle of the Filth Intercostal Space. 

The External Oblique Muscle. 

Its tendon or Aponeurosis; on the left of this number is the 

semilunar line, and on the right the middle white line (linea 

alba). 



146 PRACTICAL ANATOMY. 

14. Poupart's Ligament or the Crural Arch. 

15. The External Inguinal or Abdominal Ring; the crescentic open- 

ing to the right of 15 is the saphenous opening in the Femoral 
Aponeurosis. 

16. The Rectus Abdominis Muscle of the Right Side brought into 

view by the removal of the anterior segment of the sheath 
formed by the tendons of the Broad Muscles of the Abdomen. 
17 The Pyramidal Muscle. 

18. The Internal Oblique Muscle. 

19. The Conjoined Tendon of the Internal Oblique and Transver- 

salis Muscle 

20. The Arch formed by the Lower Border of the Internal Oblique 

and Transversalis Muscles, from beneath which the Spermatic 
Cord has been removed. 

21. Fascia Lata Femoris. 

22. Saphenous Opening. 

The Crescentic Edge of the Sartorial Fascia is seen just above Fig. 
22, and the Interior or Pubic Point of the Crescent is known as 
Hey's Ligament. 

more forward than that of the external oblique before it 
terminates in a flat tendon. 

Inserted into the cartilages of the six or seven lower 
ribs ; fleshy into the three inferior, and, by a tendinous 
expansion, which is extremely thin, resembling cellular 
membrane, into the four superior, and also into the ensi- 
form cartilage. The sheet of tendon in which the 
fleshy belly ends is continued, single and undivided, into 
the linea semilunaris, where, adhering pretty firmly to 
the tendons of the obliquus externus and transversalis, 
it divides into two layers. The anterior and more con- 
siderable layer joins the tendon of the external oblique, 
and runs over the rectus to be inserted into the w T hole 
length of the linea alba. The posterior and thinner 
layer, adhering to the anterior surface of the transver- 
salis, passes into the linea alba behind the rectus as low 
as half way between the umbilicus and os pubis ; but 
below this place the whole tendon of the internal oblique 
passes along with that of the external oblique before the 
rectus, and is inserted into the lower part of the linea 
alba. The inferior edge of the muscle extends in a 
nearly straight direction over the spermatic cord to be 
fixed by a tendinous attachment to the tuberosity of the 
pubis. 

Situation. It is covered by the obliquus descendens 
externus and latissimus dorsi. 



MUSCLES OF THE TRUNK. 147 

Use. To assist the obliquus externus ; but it bends 
the trunk in the reverse direction, so that the muscle on 
each side Co-operates with the obliquus externus of the 
opposite side. 

About the middle of Poupart's ligament, a delicate 
fasciculus of fibres is sent off from this muscle over the 
spermatic cord, where it passes under its edge in its way 
to the ring. This is named the 

Cremaster, and is continued down to the cord till it 
is insensibly lost on the tunica vaginalis testis. It will 
be seen in the dissection of the scrotum. It forms a 
covering for oblique inguinal hernia, as from what will 
be presently seen it overlies the inguinal canal. Its use 
is to suspend, draw up, and compress the testicle. 

We must now dissect the attachments of the internal 
oblique from the cartilages of the ribs, from the fascia 
lumborum, and from the spine of the os ilium, and, by 
continuing our dissection from behind forward, separate 
it from the transversalis abdominis, which lies under it. 
This separation may be continued as far as where the 
tendons of the two muscles are inseparable, i.e. rather 
more forward than the linea semilunaris. As this muscle 
lies very close upon the transversalis, caution is required 
to avoid detaching both muscles together. Let the stu- 
dent begin his separation at the crista of the ilium, where 
the course of the Circumflexa Ilii Artery and Vein 
will show him when he has arrived at the surface of the 
transversalis. 

3., Transversalis Abdominis— Arises, tendinous, 
from the fascia lumborum and back part of the spine of 
the os ilium ; fleshy from all the remaining part of the 
spine of the ilium and from the inner surface of Poupart's 
ligament; and fleshy from the inner or back part of the 
cartilages of the seven lower ribs, where its fibres meet 
those of the diaphragm. 

The fleshy fibres proceed transversely, and end in a 
flat sheet of tendon, which, after being connected to the 
other tendons at the linea semilunaris, passes with the 
posterior layer of the internal oblique behind the rectus, 
and is inserted, into the ensiform cartilage, and into the 



148 PRACTICAL ANATOMY. 

whole length of the linea alba, excepting its lowermost 
part; for, at the middle distance between the umbilicus 
and os pubis, a slit or fissure is formed in this tendon, 
through which the rectus abdominis passes; and the re- 
mainder of the tendon passes before the rectus, to be 
inserted into the lower part of the linea alba. Its in- 
ferior edge is connected with that of the internal oblique 
muscle, and the two form a common tendon (the Con- 
joined Tendon), which is inserted into the Linea Inno- 
minata, which would place it behind the external ab- 
dominal ring, and thus strengthen it. 

Use. To support and compress the viscera of the ab- 
domen. 

When the transversalis is detached from its origins, 
and turned back toward the linea semilunaris, it will be 
seen to be lined by a fascia, strongest near to Poupart's 
ligament, to which it is attached. This is named by Sir 
Astley Cooper, its discoverer, the Fascia Transver- 
salis, and prevents the bowels from being protruded 
under the inferior margins of the obliquus internus and 
transversalis muscles. It is perforated about the middle 
between the ilium and pubes, by an opening (Internal 
Abdominal Ring) for the passage of the spermatic 
cord, which then goes obliquely downward, inward, and 
forward to the ring of the external oblique. The space 
between this internal ring in the fascia transversalis 
and the external ring in the tendon of the external 
oblique is called the Inguinal Canal, and is traversed 
by an oblique inguinal hernia. If the cord be drawn 
out, the fascia transversalis follows, being prolonged into 
a funnel-shaped figure. This prolongation forms the 
Infundibular Fascia of some, and is enumerated often 
as a covering of inguinal hernia. 

In Ventro -Inguinal or Direct Hernia, the intes- 
tine comes out only through the external ring instead of 
entering the canal at the internal ring; and, as the Con- 
joined Tendon is inserted behind the external ring, it 
must carry this tendon before it (according to some), 
and will not receive a covering from the cremaster, as 
the cord which it overlies will be to the outer side of the 
tumor. 






MUSCLES OF THE TRUNK. 149 

The sheath of the rectus is now to be attended to: it 
is formed by the tendons of the three other muscles, viz.: 
the two obliqui and the transversalis. These, when they 
reach the edge of the rectus, form the appearance named 
Linea Semilunaris; they then split and inclose the rectus 
in their duplicature; the whole tendon of the external 
oblique, with the anterior layer of the internal oblique, 
passes before the rectus ; and the whole posterior layer 
of the internal oblique, together with the whole tendon 
of the transversalis muscles, pass behind the rectus, ex- 
cepting at the lower part ; but, for two or three inches 
above the pubis, all the tendons go in front of the mus- 
cle, and the posterior part of the sheath is consequently 
deficient, the rectus lying naked on the peritoneum, or 
having a very thin expansion of the transversalis fascia. 

The two oblique muscles are now to be replaced; then, 
making an incision by the side of the linea alba, and 
thus opening the sheath of the rectus through its whole 
length, you dissect it back toward the linea semilunaris, 
and thus lay bare the fibres of the muscle next to be 
described. 

4. Rectus Abdominis — Arises, by a flat tendon, from 
the forepart of the os pubis ; as it ascends, its fleshy belly 
becomes broader and thinner. 

Inserted, by a thin fleshy expansion, into the ensiform 
cartilage, and into the cartilages of the three inferior 
true ribs. 

Situation, This pair of muscles is situated on each 
side of the linea alba, under the tendons of the oblique 
muscles. The muscle is generally divided by three ten- 
dinous intersections ; the first is at the umbilicus, the 
second where it runs over the cartilage of the seventh 
rib, and the third in the middle between these; and there 
is commonly a half intersection below the umbilicus. 
By these intersections, the muscle is connected firmly 
to the interior part of its sheath, forming the Linea 
Transversa, while it adheres very slightly by loose 
cellular substance to the posterior layer. . 

Use. To compress the forepart of the abdomen, to 
bend the trunk forward, or to raise the pelvis. 



150 PRACTICAL ANATOMY. 

On each side of the linea alba, and inclosed in the 
lower part of the sheath of the rectus, is sometimes found 
a small muscle, named 

5. Pyramidalis. — Origin. Tendinous and fleshy, of 
the breadth of an inch from the os pubis, anterior to the 
origin of the rectus. 

Insertion. By an acute termination, near half-way be 
tween the os pubis and umbilicus, into the linea alba and 
inner edge of the rectus muscle. 

Use. To assist the lower part of the rectus. 

Dissection of the Cavity of the Abdomen. 

Make a longitudinal incision from the scrobiculus cor- 
dis to the umbilicus, and from that point an oblique in- 
cision on each side toward the anterior spinous process 
of the os ilium, forming thus three triangular flaps. In 
doing this, avoid cutting the intestines, by raising the 
muscles from them after the first puncture. 

Before you disturb the viscera, observe the general 
situation of those parts which appear on the first open- 
ing of the abdomen. 

1. The internal surface of the Peritoneum, smooth, 
shining, and colorless, covering the parietes of the ab- 
domen, and the surface of all the viscera. 

2. In the triangular portion of integument folded 
down over the pubes, three ligamentous cords project 
through the peritoneum, two running laterally, and the 
other in the middle, toward the navel. These are the 
remains of the two umbilical arteries and the urachus. 

3. The epigastric artery, accompanied by two veins, 
may be seen through the peritoneum, ascending ob- 
liquely upward and inward from under Poupart's liga- 
ment. Its origin from the external iliac artery, and its 
relt tion to the internal abdominal ring should be noted, 
being on its posterior wall ; and, therefore, when a hernial 
stricture occurs here, the incision should be made upward, 
to ;>void it. Close along Poupart's ligament will be seen 
the Circumflex Ilii artery, running toward the crest 
of the ilium. It comes from the external iliac artery. 



THE PERITONEUM. 151 

4. The upper edge of the liver is seen extending 
from the right hypochondriac region, across the epigas- 
tric, into the left hypochondriac region ; in it a fissure 
is seen, into which enters, inclosed in a duplicature of 
peritoneum, the ligamentum teres, which was, in the 
foetus, the umbilical vein. The fundus of the gall-blad- 
der, if distended, is sometimes seen projecting from 
under the edge of the liver. 

5. The Stomach will be found lying in the left hypo- 
chondriac region, and upper part of the epigastric ; but 
if distended, it protrudes into the umbilical region. 

6. The Great Omentum proceeds from the great 
curvature of the stomach, and stretches down like a flap 
over the intestines. 

7. The Great Transverse Arch of the Colon will 
be seen projecting through the omentum; it mounts up 
from the iliac fossa of the right side, crosses the belly 
under the edge of the liver, and under the greater curv- 
ature of the stomach, and descending again upon the 
left side, sinks under the small intestines, and rests upon 
the wing of the left iliac fossa. 

8. The Small Intestines lie convoluted in the 
lower part of the belly, surrounded by the arch of the 
colon. 

Such is the general appearance on first opening the 
abdomen; but this will vary somewhat, as one intestine 
may happen to be more inflated than another, or as the 
position of the body may have been after death. 

It will now be proper to consider the parts more mi- 
nutely. 

1. The Peritoneum. — Observe how it is reflected 
from the parietes of the abdomen over all the viscera, so 
that they may be said to be situated behind it ; trace its 
reflections from side to side, and from above downward ; 
you will see that the external coat of every viscus, a?.d 
all the connecting ligaments, are reflections or continua- 
tions of this membrane. 

(1) The Four Ligaments of the Liver are formed 
by the peritoneum, continued from the diaphragm and 
parietes of the abdomen. 



152 



PRACTICAL ANATOMY. 



Fig. 46. 
Reflections of the Peritoneum. 

1. Liver. 

2. Stomach. 

3. Small Intestine. 

4. Arch of the Colon. 

5. Duodenum. 
6 Pancreas. 

7. Rectum. 

8. Uterus. 

9. Vagina. 

10. Bladder. 

11. Peritoneum reflected a lit- 
tle farther back, from 
the Diaphragm to the 
Liver, which last it 
covers above in front 
and below, and forms 
the Anterior Lamina of 
the Lesser Omentum. 

12. It then covers the anterior 
face of the stomach, 
and forms at 13 and 14 
the anterior layer of 
the omentum majus : 
at 

15. It is reflected upward to 
form at 16 the posterior 
layer of that omentum; 
at 
17. It embraces the colon on 
its posterior surface 
and forms the posterior lamina of the mesocolon at 18 ; it then passes 
in front of the duodenum, 5, and descends to embrace the small in- 
testine, 3, whence it is reflected upward so as to give the posterior 
lamina to the mesentery, 19 ; it next passes down the posterior pari- 
etes of the abdomen, covers the rectum, 7, in front, the uterus, 8, 
the bladder, 10, and thence ascends to constitute the abdominal peri- 
toneum, 20 and 21, lines the diaphragm, and terminates above in the 
coronary ligament of the liver at 22. If we now trace the perito- 
neum from the posterior margin of that ligament, 22, we find it coat- 
ing the posterior face of the stomach, 1, and then separating from 
that organ to form the posterior lamina of the lesser omentum at 
23^; it next covers the posterior face of the stomach, 24, and is 
thence reflected downward to constitute the posterior layer of the 
anterior fold of the greater omentum, 25, 26 ; after which it turns 
upward, and forms at 27 the anterior layer of the posterior fold of 
the greater omentum ; it then invests the front surface of the colon, 
4, -and forms at 28 the anterior face of the mesocolon ; it thence 
passes upward in front of the pancreas. 6, and terminates where we 
began, at the posterior margin of the coronary ligament of the liver. 




THE MESENTERY. 153 

a. The Middle or Suspensory Ligament, inclosing 
in its duplicate the Ligamentum Teres. 

b. The Coronary Ligament, connecting the upper 
surface of the Liver to the diaphragm. 

c. The Broad Ligament of the right side. 

d. The Broad Ligament of the left side. 

(2) The Lesser Omentum, or Hepatico-Gastric 
Omentum, is formed by two laminae of peritoneum, pass- 
ing from the under surface of the liver to the lesser 
curvature of the stomach, and containing in its duplicate 
the vessels of the liver. 

(3) The Great Epiploon, Gastro-Colic or Omen- 
tum Majus. — Observe, that the peritoneum, coming 
from both surfaces of the stomach, and from the spleen, 
proceeds downward into the abdomen, and is then re- 
flected back upon itself, till it reaches the transverse 
arch of the colon, where its laminae separate to invest 
that intestine. This reflection is named the Great Omen- 
tum ; it is a pouch or bag, composed of four laminae of 
peritoneum, and the opening into it is by the Foramen 
of Winslow: observe the situation of this semilunar 
opening; it is on the right side of the abdomen, at the 
root of the lesser lobe, or lobulus spigelii of the liver ; 
it leads under the lesser omentum, under the posterior 
surface of the stomach, but above the pancreas and 
colon, into the sac of the omentum; — the omentum some- 
times reaches to the lower part of the hypogastric 
region, sometimes not beyond the navel; it contains in 
its duplicature more or less of adipose substance. 

(4) The Mesentery. — Observe, that the peritoneum, 
reflected from each side of the vertebrae, proceeds for- 
ward, to connect the intestines loosely to the spine ; that 
it begins opposite to the first lumbar vertebra, crosses 
obliquely from left to right, and ends half-way between 
the last lumbar vertebra and the groin. At its com- 
mencement, it binds down the extremity of the duode- 
num, and it terminates where the head of the colon 
begins. The great circumference which is in contact 
with the intestines is very much plaited or folded, and is 
several yards in length. Between the laminse of the mes- 



154 PRACTICAL ANATOMY. 

entery, observe the Mesenteric Glands, the branches 
of the superior mesenteric artery ramifying and forming 
arches; the mesenteric veins accompanying the arteries; 
the trunk of the lacteals, situated contiguous to the mes- 
enteric artery on its left side. It may sometimes be in- 
flated by the blowpipe. Nerves also run in the mesen- 
tery, but are not easily demonstrated. 

(5) The Mesocolon is similar to the mesentery, and 
connects, in like manner, the colon to the spine. 

2. Hepar, the Liver. — Situation. Partly in the right 
hypochondrium, which it fills up, reaching as low as the 
kidney of that side, partly in the epigastrium, and run- 
ning also some way into the left hypochondrium. 

Connected by its four ligaments to the inferior surface 
of the diaphragm, and by the lesser epiploon to the small 
curvature of the stomach. The little epiploon should now 
be removed, to discover the different parts of the liver. 

Observe the superior or convex surface adapted to the 
arch of the diaphragm ; the inferior or concave surface 
resting on the stomach ; — the posterior or thick edge 
lying against the vertebrae, and the anterior thin margin 
corresponding to the lower edge of the chest. Observe 
the three lobes of the liver ; — the great or right lobe ;* — 
the small or left lobe; — the lobulus spigelii; — the great 
fissure, separating the right and left lobe, and receiving 
the suspensory ligament, and the ligamentum teres ; — 
the cavity of the portae between the great lobe and lobu- 
lus spigelii ; — the fissure on the right side of the lobulus 
for the vena cava inferior, which fissure is almost a com- 
plete foramen ; — the notch in the back part for the ver- 
tebras ; — the depression in the right lobe for the gall- 
bladder. Observe the vessels in the cavity of the portse, 
the hepatic artery on the left side, the ductus communis 
choledochus on the right side, and betwixt, but at the 
£*.\me time behind them, the vena portae ; they are all 
surrounded by a plexus of nerves. From the sympa- 
thetic and par vagum these vessels and nerves pass along 



1 Two others are enumerated, the lobulus caudatus and quadratus. 
See Special Anatomy. 



THE STOMACH. 155 

the edge of the little omentum, surrounded and connected 
by adipose and cellular substance ; the part is called 
Capsula Glissoni. Observe that the ligamentum teres 
was the umbilical vein of the foetus, entering the vena 
portae, and that the ductus venosus in the foetus (obliter- 
ated in the adult), leaving the vena porte, passed into 
one of the venoe cavae hepaticse. 

3. VesiculaFellis, the GrALL-B ladder. — Situation. 
In the right hypochondriura, in a superficial depression 
on the under surface of the right lobe of the liver : it 
sends off the Ductus Cysticus, which, uniting w r ith the 
Ductus Hepaticus, forms the Ductus Communis Cho- 
ledochus : this perforates the first curvature of the 
duodenum. 

4. Ventriculus, the Stomach. — Situation. In the 
left hypochondriac and epigastric regions. Connected to 
part of the interior surface of the diaphragm, to the con- 
cave surface of the liver by the little omentum, to the 
spleen by a reflection of peritoneum, and to the arch of 
the colon by the great omentum. Observe its greater 
curvature looking downward, its lesser curvature looking 
upward ; and its two lateral surfaces. In the living body, 
the greater curvature is turned forward, and a little down- 
ward, the lesser arch backward, i.e. toward the spine, 
while one of the lateral convex sides is turned upward, 
and the other downward. Observe the bulging extremity 
on the left side, the cardia or upper orifice, where the 
oesophagus enters half-way between this great extremity 
and the lesser arch : the pylorus, or lower orifice, at the 
end of the small extremity, situated under the liver, and 
rather to the right side of the spine, feeling hard when 
touched. A constriction may be seen where the stomach 
ends in the duodenum, it marks the position of the py- 
loric valve in the inside. 

5. The Intestines. — These form one continuous tube, 
but are divided into two portions, differing in their figure, 
structure, and functions, and distinguished by the names 
of small and large. 

The small intestine is divided into duodenum, jejunum, 
and ileum; the large into caecum, colon, and rectum. 



156 



PRACTICAL ANATOMY. 
Fie. 47. 




10. 

11. 

12. 

13, 14. 

15. 
16. 
17. 

18 
19. 
20. 
21. 
22. 
23. 
24. 
25. 
26. 
27. 



6 32 
Under or Concave Surface of the Liver. 

Right Lobe, 

Left Lobe. 

Its Anterior or Inferior Edge. 

Its Posterior or Diaphragmatic Portion. 

Right Extremity. 

Left Extremity. 

Notch in the Anterior Margin. 

Umbilical or Longitudinal Fissure. 

Round Ligament or Remains of the Umbilical Vein. 

Portion of the Suspensory Ligament in connection with the 
Round Ligament. 

Pons Hepatis, or Band of Liver across the Umbilical Fissure. 

Posterior End of Longitudinal Fissure. 

Attachment of the obliterated Ductus Venosus to the Ascend- 
ing Vena Cava. 

Transverse Fissure. 

Section of the Hepatic Duct. 

Hepatic Artery. 

Its Branches. 

Vena Portarum. 

Its Sinus, or Division into Right and Left Branches. 

Fibrous Remains of the Ductus Venosus. 

Gall-bladder. 

Its Neck. 

Lobulus Quartus. 

Lobulus Spigelii. 

Lobulus Caudatus. 

Inferior Vena Cava. 



THE SMALL INTESTINE. 157 

28. Curvature of Liver to fit the Ascending Colon. 

29. Depression to fit the Right Kidney. 

80. Upper Portion of its Right Concave Surface over the Renal 
Capsule. 

31. Portion of the Liver uncovered by the Peritoneum. 

32. Inferior Edge of the Coronary Ligament in the Liver. 

33. Depression made by the Vertebral Column. 

(1) Small Intestine ; — about four times the length 
of the body. 

a The Duodenum is broader than any other part of 
the small intestine, but is short ; it takes a turn from the 
pylorus upward, and to the right side, passing under the 
liver and gall-bladder; then, turning upon itself, it de- 
scends, passing as low as the right kidney ; it is in this 
space that it receives the pancreatic and gall ducts; 
thence it crosses before the renal vessels, before the aorta, 
and upon the last dorsal vertebra, firmly bound down by 
the peritoneum, which covers only its anterior surface ; 
it then ascends from right to left, till it is lost under the 
root of the mesocolon. 

Turning back the colon and omentum, fixing them 
over the brim of the thorax, and pushing down the small 
intestine toward the pelvis, you find the duodenum 
coming out from under the mesocolon, but still tied close 
to the spine; it terminates in the jejunum, exactly where 
the mesentery begins. The intestine in this course forms 
nearly a circle, the root of the mesocolon being the only 
part lying between its two extremities. 

You have now to trace the rest of the small intestine, 
which lies convoluted in the umbilical and hypogastric 
regions. 

b. Jejunum constitutes the first or upper half of the 
remaining small intestine, and is situated more in the 
upper part of the abdomen; it is redder, and its coats 
feel thicker to the touch, from the greater number of the 
valvule conniventes on its inner surface; its diameter 
exceeds that of the ileum. 

e. The lower half is named Ileum ; it is situated more 
in the lower part of the abdomen, and terminates in the 
great intestine, by entering the caput coli, or beginning 
of the colon. 



158 



PRACTICAL ANATOMY. 

Fig. 48. 




The Digestive Tube, from the (Esophagus to the Anus. 

1. (Esophagus, which is laid open at 2, to show its termination 

in the cardiac orifice of the stomach. 
3. Interior of the Stomach with its rugae. 
. 4. Duodenum, commencing at the Pylorus. 
5. Gall-bladder with the Cystic Duct, which last passes down- 
ward to open into the duodenum. 
), 6. Small Intestine, terminating in 7, the Caecum. 

8. Appendicula Vermiformis. 

9. Right ascending Colon. 

10. Transverse Arch of the Colon. 

11. Left descending Colon. 13. Rectum. 

12. Sigmoid Flexure. 14. Anus. 



THE GREAT INTESTINE, 159 

As a general observation it may be said that the con- 
volutions of the small intestine occupy the middle of the 
umbilical and hypogastric regions; but their situation 
varies much, particularly according to the state of the 
bladder and rectum. The course of the tube, independ- 
ently of its convolutions, is from the left lumbar region, 
where the duodenum emerges from under the mesocolon 
to the right inguinal region, where the ileum terminates 
in the caput coli. Here a duplicature of the internal 
membrane into two folds, forms the ileo-caecal valve. 

(2) Great intestine. 

d. The Cecum, or blind gut, is tied down by the 
peritoneum to the loins on the right side, lying in the 
space under the right kidney, hid by the convolutions of 
the ileum. On its posterior part there is a little ap- 
pendage, of the shape of an earth-worm, named Appendix 
Cseci Vermiforrnis. 

e. The Colon. — Its commencement at the Caecum is 
termed Caput Coli, or head of the colon; it mounts up- 
ward from the caecum over the anterior surface of the 
right kidney, passes under the gall-bladder, which, after 
death, tinges it with bile; and then, going across the 
upper part of the belly, forms its Great Transverse 
Arch. In its whole course it is contracted into cells by 
its muscular fibres, which are united together, forming 
longitudinal bands ; and it has some fatty projections 
attached to its surface, named Appendices Epiploicae. 
Both these circumstances distinguish the large from the 
small intestine ; which the difference of size does not 
always. The colon then goes backward under the stom- 
ach and spleen into the left hypochondrium; and then, 
descending over the left kidney, it is again tied down ; 
it afterward turns over the brim of the pelvis, being at 
this part unconfined, and forming a loose and remarkable 
curvature, which is named the Sigmoid or Iliac Flex- 
ure. After this convolution, the intestine assumes the 
name of 

The Rectum. — Drawing aside the intestines, you find 
the gut continued over the anterior surface of the sacrum 
and os coccygis to the anus. 



160 



PRACTICAL ANATOMY. 
Fig. 49. 




Ileo-Cjecal Valve. 



a. The Terminal Part of the 

Ileum. 

b. The Ileo-C^cal Valve. 

c. The Caecum. 



The Appendieula Vermi- 

formis. 
The Commencement of the 

Colon. 



On pulling the stomach toward the right side, you will 
perceive 

6. The Lien, or Spleen. — Situation. In the left 
hypochondriac region, between the great extremity of 
the stomach, and the neighboring false ribs, under the 
edge of the diaphragm, to all of which it is connected 
by the peritoneum. It is of an oval figure; its external 
surface is gently convex; its internal surface irregularly 
concave, and divided by a longitudinal fissure, into which 
its vessels enter. 

7. The Pancreas. — Situation. This organ was in part 
seen on removing the little epiploon ; it is more fully ex- 
posed by tearing through the great epiploon, between the 
great curvature of the stomach and the transverse arch 
of the colon. It lies in the cavity into which the foramen 
of Winslow leads ; it extends from the fissure of the 
spleen across the spine, under the posterior surface of 
the stomach, and terminates within the circle formed by 
the duodenum; it is only covered on its anterior surface 
by the peritoneum. 



THE KIDNEYS. 161 

The Pancreatic Duct pierces the coat of the duode- 
num, and enters the cavity of that intestine by an orifice 
common to it and to the ductus communis choledochus. 
The duct runs along the very centre of the gland, where 
the whiteness of its coats will readily enable the student 
to distinguish it. 

All the abdominal viscera may now be removed, ex- 
cept the rectum, where it descends into the pelvis, which, 
being tied, should be allowed to remain, for it belongs to 
the demonstration of those parts ; or the liver and its 
vessels, with the pancreas, may be left, and the vessels 
entering the portae of the liver traced. 

The student should open the different portions of the 
intestine, and mark the folds of the mucous membrane, 
Valvule Conniventes; also, the small eminences over 
those folds, Villi. He should also examine the Pylo- 
ric Valve ; the Ileo-C^cal Valve, at the termination 
of the ileum. Little bodies are frequently seen under 
the mucous membrane of the duodenum, the Glands of 
Brunner, and other patches of ductless glands in the 
ileum, the Glands of Peyer. 

The peritoneum should now be carefully dissected from 
the diaphragm, and from the sides and back part of the 
abdomen; thus the parts which lie more immediately 
behind that membrane may be examined. 

8. Renes, the Kidneys. — Two glandular bodies, 
situated in the posterior part of the cavity of the abdo- 
men, on each side of the lumbar vertebrae, between the 
last false rib and the spine of the ileum, and imbedded 
in a quantity of adipose membrane. 

Observe the renal or emulgent artery entering the vein 
and ureter passing out of its fissure. Observe the course 
of the ureter; it passes behind the peritoneum over the 
psoas muscle into the pelvis, and runs between the rec- 
tum and bladder, which last it enters. 

If the kidney be laid open from its convex to its con- 
cave margins, the following points may be observed : 
An exterior or Cortical Portion; an internal, which 
being arranged in cones, formed of uriniferous tubes, 
the Tubular or Conical part. These cones look into 

8* 



162 



PRACTICAL ANATOMY. 



three cavities, Infundibula, and these again into the 
Pelvis, and this into the ureter. 



Fig. 50. 



Longitudinal Section op the Kidney, with its Renal Capsule. 




1. Renal Capsule. 

2. Cortical or vascular part of 

the Kidney. 

3, 3. Uriniferous Tubes collected 

into conical Fasciculi. 

4, 4. Papillse, projecting into their 

corresponding calices. 
5, 5, 5. The Three Infundibula. 

6. Pelvis of the Kidney. 

7. Ureter. 



9. The Capsule Renales. — Two glandular bodies, 
situated on the upper extremity of each kidney, of an 
irregular figure, crescent-like, or somewhat triangular. 

By the removal of the peritoneum, several muscles are 
exposed, situated at the superior and posterior parts of 
the abdomen. 

One single muscle is situated in the superior part of 
the abdomen. 

Diaphragma, the Diaphragm, or Midriff. — This is 
a broad, thin, muscular septum between the thorax and 
abdomen, situated obliquely; it is concave below, and 
convex above, the middle of it on each side reaching as 
high within the thorax as the fourth rib. It is divided 
into two portions. 

1. The superior or greater muscle of the diaphragm 



THE DIAPHRAGM. 163 

forms the transverse partition between the chest and ab- 
domen, 

Arising, by distinct fleshy fibres, 1. From the poste- 
rior surface of the ensiform cartilage; 2. From the carti- 
lages of the seventh, and all the false ribs; 3. From the 
ligamentum arcuatum, which is a ligament extended, 
somewhat indistinctly, from the top of the twelfth rib to 
the lumbar vertebrae, forming an arch over the psoas and 
quadratus lumborum muscles. From these origins the 
fibres run, in different directions, like radii from the cir- 
cumference to the centre of a circle, and are 

Inserted into a broad tendon (tendinous centre, or cor- 
diform tendon), which is situated in the middle of the 
diaphragm, and in which, therefore, the fibres from the 
opposite sides are interlaced. 

2. The inferior or lesser muscle, or appendix of the 
diaphragm, lies on the bodies of the vertebrae, and 

Arises, by four small tendinous feet, on each side, 
from the second, third, and fourth lumbar vertebrae; 
these tendons soon join, to form a strong pillar on each 
side, named the Crus of the Diaphragm. The crura run 
obliquely upward and forward, form two fleshy bellies, 
a fasciculus of each of which crossing over to the other, 
decussates with the opposite one, and thus forms the 
interval of the two crura into a superior and inferior 
opening. 

Inserted into the posterior part of the middle cordi- 
form tendon. 

Situation. The diaphragm is covered on its superior 
surface by the pleura, and on its inferior by the perito- 
neum; it separates the thoracic from the abdominal 
viscera. It is perforated in its fleshy and tendinous parts 
by several bloodvessels, and other important organs. 

(1) The aorta passes between the tendinous part of 
the crura, lying close upon the spine ; and the thoracic 
duct passes betwixt the aorta and the right crus. 

(2) A little above, and to the left side of the aorta, 
the oesophagus, with the eighth pair of nerves attached to 
it, passes through an oval fissure formed in the fleshy- 
columns of the inferior muscle. 



.164 



PRACTICAL ANATOMY. 



(3) The vena cava perforates the tendon toward the 
right side. 

Fig. 51. 




The Diaphragm. 



1, 2, 3. Tendinous Centre of the 
Greater Diaphragm. 
5, 6. Ligamentum Arcuatum. 

7. Foramen of the Lesser 

Splanchnic Nerve. 

8. Right Crura of Dia- 

phragm. 

9. Fourth LumbarVertebra. 
10. Left. Crura of Dia- 
phragm. 



11. Hiatus Aorticus. 

12. Foramen (Esophageum. 

13. Foramen Quadratum, for the 

Passage of the Vena Cava. 

14. Psoas Muscle. 

15. Quadratus Lumborum. 

16. Transverse Processes of the 

Lumbar Vertebras. 



(4) The great splanchnic nerve, and branches of the 
vena azygos vein, perforate some of the posterior fibres 
of the crura. The lesser splanchnic nerve also passes 
through an opening in the substance of the crura. 

(5) On each side of the sternum there is a small fis- 
sure, where the peritoneum and pleura are only separated 
by adipose membrane. 

Use. The diaphragm is one of the chief agents in 
respiration ; it also acts in coughing, laughing, and speak- 
ing, and in the expulsion of the urine and feces, etc. 



THE PSOAS MAGNUS MUSCLE. 



165 



Four pair of muscles are situated within the posterior 
part of the cavity of the abdomen. 

1. The Psoas Parvus, often wanting. — It arises, 
fleshy, from the sides of the last dorsal and first lumbar 
vertebras; it sends off* a small long tendon, which, run- 
ning on the inside of the psoas magnus, is 

Inserted, thin and flat, into the brim of the pelvis, at 
the junction of the os ilium and pubis. 

Use. To assist the psoas magnus in bending the loins 
forward. 

2. The Psoas Magnus. — It arises, fleshy, from the 

Fig. 52. 




1. Small Psoas Muscle. 

V '. Insertion of the Tendon of the same into the Iliac Fascia cut. 

2. Great Psoas Muscle. 

3. Quadratus Lumborum Muscle, partly concealed by the two 

Psoas Muscles. 
3 7 . Same of the Right Side entirely exposed 

4, 4. Foramina formed by the Grooves upon the Bodies of the Lum- 

bar Vertebrae, and the Origins of the Great Psoas Muscle, 
for the passage of the Lumbar Arteries and Veins. 

5, 5. Inter-Transverse Muscles. • 

6. Iliac Muscle entirely exposed by the removal of '2, Great Psoas 
Muscle cut. 



166 PRACTICAL ANATOMY. 

side of the body, and transverse process of the last 
vertebra of the back, and in the same manner from all 
those of the loins, by as many distinct slips. It runs 
down over the brim of the pelvis, and is 

Inserted, tendinous, into the trochanter minor of the 
os femoris, and fleshy, into that bone immediately below 
the trochanter. 

Situation. It is situated betwixt the psoas parvus and 
iliacus internus. 

Use. To bend the thigh forward, roll it outward; or, 
to assist in bending the body. 

3. The Iliacus Internus. — It arises, fleshy, from the 
transverse process of the last vertebra of the loins, from 
all the inner margin of the spine of the os ilium, from 
the edge of that bone between its anterior superior spi- 
nous process and the acetabulum, and from all its hollow 
part between the spine and the linea innominata. Its 
fibres descend under the outer half of Poupart's ligament, 
and join the tendon of the psoas magnus. 

Inserted with the psoas magnus. 

Situation. It fills up the internal concave surface of 
the os ilium. It is covered by a pretty strong fascia, 
which is inserted into the crista of the ilium, and into 
the crural arch, Fascia Iliaca: at which point it joins 
the Fascia Transversalis. This Iliac Fascia passes 
under the iliac bloodvessels into the pelvis. The latter 
insertion prevents the bowels from descending under 
Poupart's ligament, except at the inner edge of the iliac 
vein, which is accordingly the situation of a crural hernia, 
and which the student should examine most carefully. A 
part of this fascia is also continued behind the femoral 
vessels over the pubis, to form a part of the sheath which 
incloses those vessels. A short distance to the pubic 
side of the iliac vein, a strong semilunar tendinous edge 
is seen; this is one of the attachments of Poupart's liga- 
ment to the linea innominata, and is called Grimlernat's 
ligament. Between this and the femoral vein is a space 
filled by a lymphatic gland and cellular tissue. The last 
called the Septum Crurale. This space is the Femoral or 
Crural ring, and is the place where an intestine some- 



AORTA AND ITS BRANCHES. 167 

times passes through, forming Femoral Hernia. The sep- 
tum crurale would form one of its coverings. Remember 
these points, and apply them when conducting the dis- 
section of the thigh. 

Use. To assist in bending the thigh, and in bringing 
it directly forward. 

N. B. The insertion of the two last described muscles 
cannot be seen till the thigh is dissected. 

4. The Quadratus Lumborum. — This muscle arises, 
tendinous and fleshy, from rather more than the posterior 
third part of the spine of the os ilium. 

Inserted into the transverse processes of all the ver- 
tebrae of the loins, into the posterior half of the last rib, 
and, by a small tendon, into the side of the last vertebra 
of the back. 

Situation. It is situated laterally at the lower part of 
the spine, more outwardly than the psoas magnus. 

Use. To move the loins to one side, pull down the last 
rib. If both act, to bend the loins forward. 

Of the Vessels and Nerves situated behind the 
Peritoneum. 

1. The Arteries, viz,: The Aorta Abdominalis, and its 
branches. 

The Aorta passes from the thorax into the abdomen, 
between the crura of the diaphragm, close upon the spine. 
It then descends on the forepart of the vertebrae, inclined 
to the left side. On the fourth lumbar vertebra, it bifur- 
cates into the two primitive or common iliac arteries. 

Branches of the Abdominal Aorta. — 1. The two 
Phrenic Arteries arise from the Aorta, before it has 
fairly entered into the abdomen, and ramify over the 
diaphragm. 

2. The Cceliac Artery or Axis comes off at the point 
where the aorta has fairly extricated itself from the dia- 
phragm, surrounded by the meshes of the semilunar gan- 
glion. It divides into three branches. 

(1) A. Gastrica, smallest of the three. It passes along 



168 



PRACTICAL ANATOMY. 



th£ lesser curvature from left to right, to inosculate with 
the pylorica or coronaria dextra. 

Fig/53. 




Abdominal Portion of the Aorta and its Branches. 



1. Aorta. 
2, 2. Primitive Iliac Arteries, 
♦i. C celiac Artery cut across. 



4. Superior Mesenteric cut. 

5. Inferior Mesenteric cut. 

6. Middle Sacral. 



AORTA AND ITS BRANCHES. 169 

7, 7. Diaphragmatic or Phrenic 12. Internal Iliac Artery. 

Arteries. 13, 13. Epigastric Artery. 

8, 8. Renal Arteries. 14. Circumflex Iliac Artery. 

9, 9. Spermatic Arteries. 15, 16. M u s culo -cut an e ous 

10. Lumbar Arteries. Nerves. 

11. External Iliac Artery. 

(2) Arteria Splenica passes under the stomach, and 
along the upper border of the pancreas; it enters the 
spleen, and gives off the following branches: 

a. Pancreatic^ Parv^ to the pancreas, where it 
runs along the border of that viscus. 

b. Vasa Brevia to the bulging extremity of the 
stomach. 

c. A. Gastro-Epiploica Sinistra, along the greater 
curvature of the stomach, inosculating with the gastro- 
epiploica dextra. 

(3) Arteria Hepatica runs to the liver. It sends 
off the following branches : 

a. Pylorica. — It sends its ramifications along the 
lesser curvature, to inosculate with the proper coronary 
artery. 

b. Gastro-Epiploica Dextra, or Gastro-Duode- 
NALis, passes under the pylorus, and along the great 
curvature of the stomach, inosculating with the gastro- 
epiploica sinistra (from the splenic), and sends off a 
branch to the pancreas. 

The hepatic artery then divides into the right and left 
hepatic. The Right is distributed to the right lobe of 
the liver, and to the gall-bladder. The Left supplies 
the whole of the left lobe, the lobulus spigelii, and part 
of the right lobe of the liver. 

3. The Superior Mesenteric Artery. — It leaves 
the aorta about half an inch lower than the coeliac ar- 
tery ; it enters the fold of peritoneum forming the mesen- 
tery, and runs down in this, incurvating from the left to 
the right side. 

From the right side or concavity of this arch, three 
branches are given to the colon. 

(1) A. Ileo-Colica to the caput coli and last of the 
ileum. 

(2) A. Colica Dextra to the right side of the colon. 

(3) A. Colica Media to the arch of the colon. 



170 



PRACTICAL ANATOMY. 
Fig. 54. 




The Several Parts of the Large Intestine. 

a. The Caecum. 

b. Right or Ascending Colon. 

c. Transverse Colon, or Arch of the Colon. 

d. Left or Descending Colon. 

?, e. Sigmoid Flexure of the Colon. 
f: Rectum. 
g. Mesocolon. 

h. The end of the Ileum, or its termination at thelleo-caacal Valve. 
i. Appendicula Vermiformis. 
k. Pouch of the Rectum. 
I. Anus. 
m. Appendices Epiploicae. 



THE SEVERAL PARTS OF THE LARGE INTESTINE. 171 

The convexity of the arch of the superior mesenteric 
sends off from sixteen to twenty branches, which, form- 
ing frequent anastomoses and arches, proceed to the 
small intestines. 

4. The Renal or Emulgent Arteries are two in 
number. Below the superior mesenteric, pass to the 
kidney. The right artery longer than the left, and 
passes behind the vena cava ascendens. 

5. The Spermatic Arteries are also two; they come 
off an inch below the emulgent from the forepart of the 
aorta. Each artery descends in its course, accompanied 
by the spermatic vein and nerves. It passes through 
the abdominal rings, and enters the upper part of the 
testicle. In the female it supplies the ovaria and fundus 
uteri. 

6. The Inferior Mesenteric is a single trunk. 
Comes off rather from the left side of the aorta, below 
the spermatic arteries ; it passes in the mesentery to the 
left side of the abdomen, where it divides as follows : 

(1) The Colica Sinistra. To the left side of the 
colon. Inosculates with the A. Colica Media. 

(2) Branches which pass to the sigmoid flexure. 

(3) The great trunk of the artery runs down to the 
rectum, on which it ramifies. Is termed Art. Hemor- 
rhoidals Superius. 

7. The Lumbar Arteries are five or six small arte- 
ries on each side, which arise from the back part of the 
aorta, and are distributed to the spinal canal, muscles 
of the spine, and of the sides of the abdomen and pelvis. 

8. A. Sacra Media is a single artery, arises from the 
back part of the aorta at its bifurcation, and descends 
along the anterior surface of the sacrum, giving twigs to 
all the neighboring parts. 

At the fourth lumbar vertebra, the aorta bifurcates 
into the two primitive or common iliacs. 

The Iliaca Communis runs along the edge of the 
psoas muscle, and at an inch or two from its origin di- 
vides into 

(1) The Internal Iliac which passes down into the 
pelvis. 



172 PRACTICAL ANATOMY. 

(2) The External Iliac, which, following the direction 
of the psoas muscle, passes under Poupart's ligament, 
and becomes the Femoral artery. 

2. Veins. 

The Vena Cava Abdominalis, vel Inferior, is formed 
by the junction of the two common iliac veins ; it passes 
up through the abdomen on the right side of the aorta. 

In this course it receives the following veins, which 
resemble their corresponding arteries : 

1. The Lumbar Veins. 

2. The Emulgent or Renal Veins: the left is the 
longest, as it crosses over the forepart of the aorta. 

3. The Right Spermatic Vein; the left enters the left 
renal vein. 

The vena cava then passes through the fissure of the 
liver, being nearly surrounded by that viscus, and re- 
ceiving three branches from it, called the Ven^i He- 
patic^. It then perforates the diaphragm, and enters 
the thorax. 

The common iliac vein of each side is formed by the 
union of two branches, the External and Internal 
Iliac Veins, which accompany the arteries of the same 
name. The common iliac vein of each side lies on the 
inside of its artery ; hence both veins cross behind the 
right iliac artery, to unite and form the vena cava, on 
the forepart of the lumbar vertebrae. 

do not join the cava, but 
are united behind the 
pancreas, to form the 
Vena Portae. This vein 
( ramifies anew through 
the liver, and its blood is 
returned into the vena 
cava by the venae cavae 
hepaticse. 

Although the trunks just enumerated are the chief 
vqins that contribute to form the vena portae, yet the 
returning veins of all the viscera inclosed in the peri- 



The Superior Mesen- 
teric Vein, the Inferior 
Mesenteric Vein, and the 
Splenic Vein 



NERVES. 173 

toneura, except the liver, are included in the same sys- 
tem, and join one or other of the large trunks. This is 
the case with the stomach, pancreas, gall-bladder, and 
omentum. The blood which goes to the spleen, large 
and small intestines, is all returned by the three great 
trunks. 

3. Nerves. 

1. The eighth pair, or Par Vagum, descending on 
each side of the oesophagus through the diaphragm, 
forms the two Stomachic Plexuses on the anterior and 
posterior surfaces of the stomach. These plexuses send 
some branches to the coeliac, to the hepatic, and to the 
splenic plexus. 

2. The Splanchnic Nerve, or Anterior Intercostal, 
a branch sent off by the intercostal nerve in the thorax, 
enters the abdomen betwixt the crura of the diaphragm ; 
here each nerve forms a Semilunar Ganglion by the 
side of the coeliac artery. 

From the ganglion on each side branches are sent 
across, which communicate intimately together, and 
form round the root of the coeliac artery a very inti- 
mate plexus, containing several ganglia of various sizes, 
formerly called the Solar or Oceliac Plexus. Nerves 
pass from this plexus, with the branches of the aorta, to 
the various viscera of the abdomen ; they form the He- 
patic, Splenic, Superior and Inferior Mesenteric, 
Renal, and Spermatic Plexuses. 

3. The trunk of the sympathetic nerve (the posterior) 
perforates the diaphragm close to the spine, and runs 
along the upper edge of the psoas magnus. It terminates 
on the extremity of the os coccygis by union with the 
nerve of the opposite side, in a ganglion (Ganglion 
Impar). In this course it communicates with the lum- 
bar nerves and the various abdominal plexuses. 

The Thoracic Duct may be seen passing from the 
abdomen into the thorax, between the aorta and the 
right crus of the diaphragm. It is larger here than in 
its subsequent course. It empties into the junction of 
the left subclavian and internal jugular veins. 



174 PRACTICAL ANATOMY. 



CHAPTER XL 

DISSECTION OF THE ANTERIOR PART OF THIGH. 

Carry an incision from the middle of Poupart's liga- 
ment obliquely across the thigh, and around the internal 
condyle of the femur to the tubercle of the tibia. Reflect 
the integuments. The superficial fascia, especially at the 
groin, is lamellated; and situated in it about Poupart's 
ligament a cluster of lymphatic glands. In and beneath 
this fascia notice 

1. The Vena Saphena Major, seen running up in 
the inside of the knee and thigh. At first it lies very 
superficial, betwixt the skin and fascia lata. As it ascends 
it is gradually enveloped by the fibres of the fascia, and 
then sinks beneath it to join the femoral vein about an 
inch below Poupart's ligament. The space through w T hich 
it sinks to join the femoral vein is the Saphenous 
Opening, and the loose cellular tissue which envelops 
the vein and occupies the opening is called the Cribri- 
form Fascia. In its course it is joined by several 
cutaneous veins. 

2. Immediately under the true skin you may occa- 
sionally perceive the Lymphatic Vessels running, like 
lines of a whitish color, to enter the inguinal glands. 

3. Several Cutaneous Nerves are seen ramifying 
above the fascia. They all come from the lumbar nerves 
or anterior crural nerve. 

The deep fascia, or Fascia Lata, may now be exposed 
distinctly by carefully clearing away the superficial 
fascia ; preserving, however, the saphena vein, a short 
distance down. Observe how extensively it arises from 
the bones, tendons, and ligaments. On the anterior 
and superior part of the thigh, it arises from Poupart's 
ligament, from the os pubis, from the descending ramus 
of that bone, and from the ascending ramus and tuber- 
osity of the ischium ; behind, and on the outside, from the 



ANTERIOR PART OF THIGH. 



175 




Dissection of some of the Parts concerned in Femoral and 
Inguinal Hernia. 

1. Tendon of the External Oblique Muscle. 

2. Tendon of the Internal Oblique, the first-named muscle being 

dissected off. 

3. Cribriform Fascia. 

4. Vena Saphena. 

5. External Abdominal Ring and Spermatic Cord. 

6. Poupart's Ligament. 



176 PRACTICAL ANATOMY. 

whole spine of the ilium, and from the sacro-sciatic liga- 
ments. It receives a number of fibres from a muscle 
belonging to it, viz., the tensor vaginae femoris, and 
from the tendon of the gluteus-maximus; it passes down 
over the whole thigh, is firmly fixed to the linea aspera, 
to the condyles of the femur, and to the patella, and is 
continued over the knee, to be attached to the heads of 
the tibia and fibula, after which it forms the fascia of 
the leg. 

On the upper and anterior part of the thigh, below 
Poupart's ligament, there is a slight hollow, where the 
great vessels descend under the crural arch. The fascia 
lata forms, just on the outside and upper part of this, a 
crescent-shaped fold, called its semilunar edge, which is 
strongly connected to the crural arch and linea innomi- 
nata. The commencement of this semilunar edge, some- 
times called the Superior Cornu, is Hey's Ligament. 
The fascia on the outside of the saphenous opening is 
called the Sartorial, that on the inside the Pectineal. 
If the cribriform fascia be removed from between the 
two, we will see the femoral bloodvessels lying beneath 
inclosed in their sheath. Press the finger down from 
the inside of the abdomen on the pubic side of the iliac 
vein, and it will be found to project in the thigh on the 
inner side of the femoral vein, but within its sheath. 
This space is the crural ring, and gives you the course 
of a femoral hernia, which projects forward, after pass- 
ing under Poupart's ligament through the saphenous 
opening, covered, as you may perceive, by the perito- 
neum, septum crurale, fascia propria, or sheath of the 
vessels, cribriform fascia, superficial fascia, and skin. 

The fascia should now be dissected back; and, in 
lifting up the thicker part of it, which covers the outside 
of the thigh, observe that it is composed of two laminae 
01 fibres. The fibres of the outer lamina run in circles 
round the thigh, while those on the inside, which are 
stronger and more firmly connected, run longitudinally. 



MUSCLES OF THE THIGH. 
Fig. 56. 



177 




The Femoral or Crural Arch, and the Structures situated be- 
tween IT AND THE ANTERIOR PART OF THE SUPERIOR MARGIN OF 

the Pelvis. 

1. The Crural Arch, or Poupart's Ligament. 

2. Pubic Bone. 

3. Superior Anterior Spine of the Ilium. 

4. Spine of the Pubis. 

5. Pectineal Line, and the Insertion of Gimbernat's Ligament. 

7. Iliac Muscle cut. 

8. Crural Nerve cut. 

9. Great Psoas Muscle cut. 

10. Point at which the Crural Branch of the Genito-Crural Nerve 

reaches the Thigh. 

11. Femoral Artery. 

12. Femoral Vein, receiving the Saphena Vein. 

13. External Portion of the Sheath of the Femoral Vessels lying in 

contact with the Femoral Artery. 

14. The large funnel-shaped Cavity of the Sheath on the Inner Side 

of the Femoral Vein. 

15. Internal Femoral Ring, bounded above by the Crural Arch, be- 

hind by the Pubis, externally by the Vein, and internally by 
the free edge of (16) Gimbernat's Ligament. 

Muscles Situated on the Forepart and Inside of the 
Thigh. 

These are nine in number. 

1. The Tensor Vaginae Femoris — Arises, by a nar- 
row, tendinous, and fleshy origin, from the external part 
of the anterior superior spinous process of the os ilium-; 
it forms a considerable fleshy belly. 

9 



178 PRACTICAL ANATOMY. 

Inserted into the inner side of the great fascia, where 
it covers the outside of the thigh, and a little below the 
trochanter major. 

Use. To stretch the great fascia of the thigh, and 
assist in its abduction. 

2. The Sartorius — Arises, by short tendinous fibres, 
from the anterior superior spinous process of the os 
ilium, soon becomes fleshy, extends obliquely across the 
thigh, and passes behind the inner condyle. 

Inserted, by a broad and thin tendon, into the inner 
side of the tibia, immediately below its anterior tubercle. 

Situation. It lies before the muscles of the thigh, 
crossing them like a strap about two inches in breadth. 
At the lower part of the thigh, it runs between the ten- 
don of the triceps adductor magnus, and that of the 
gracilis. It is inserted above tendons of the gracilis 
and semitendinosus, over which it sends an aponeurotic 
expansion. 

Use. To bend the leg obliquely inward on the thigh, 
and to bend the thigh forward. 

It crosses over the femoral artery. 

3. The Eectus Femoris — Arises, by a strong tendon, 
from the inferior anterior spinous process of the os ilium ; 
and, by another strong tendon, from the dorsum of that 
bone a little above the acetabulum, and from the capsu- 
lar ligament of the hip-joint. The two tendons soon 
unite, and send off a large belly, which runs down over 
the anterior part of the thigh, and terminates in a flat 
strong tendon, which is 

Inserted into the upper extremity of the patella. 

Situation. To expose the tendinous origins of this 
muscle, the origins of the sartorius and tensor vaginae 
.femoris must be raised. Its insertion lies betwixt the 
two vasti. 

Use. To extend the leg on the thigh, and to bend 
the thigh on the pelvis ; to bring the pelvis and thigh 
forward to the leg. 

Under the rectus, and partly covered by it, there is a 
large mass of flesh, which, at first sight, appears to form 
but one muscle. It may, however, be divided into three; 



MUSCLES OF THE THIGH. 



179 



the separation on the external surface is not generally 
very evident, but, by following the course of the vessels 
which enter this mass, and by cutting through perhaps a 
few fibres externally, you will discover the line of sepa- 
ration; and this separation, as you proceed deeper with 
your dissection, will become very distinct. The three 

Fig. 57. 
A View of the Muscles on the Front of the Thigh. 



1. Tensor Vaginae Femoris. 

2. Pectineus. 

3. Rectus Femoris. 

4. Vastus Externus. 

5. Vastus Internus. 

6. Sartorius. 

7. Adductor Longus. 




muscles are named vastus externus, vastus internus, and 
cruraus : at the upper and middle parts of the thigh, 
they may be separated very distinctly; but for two or 



180 PRACTICAL ANATOMY. 

three inches above the condyles they are connected in- 
separably. 

4. The Vastus Externus — Arises, tendinous and 
fleshy, from the anterior surface of the root of the tro- 
chanter major, from the outer edge of the linea aspera, 
its whole length, from the oblique line running to the 
external condyle, and from the whole external flat sur- 
face of the thigh-bone. The fleshy fibres run obliquely 
forward. 

Inserted into the external surface of the tendon of 
the rectus cruris, and into the side of the patella. 

Situation. This muscle forms the large mass of flesh 
on the outside of the thigh. 

Use. To extend the leg, or to bring the thigh forward 
upon the leg. 

5. The Vastus Internus — Arises, tendinous and 
fleshy, from the forepart of the root of the trochanter 
minor, from all the upper edge of the linea aspera, from 
the oblique line running to the inner condyle, and from 
the whole internal surface of the thigh-bone. Its fibres 
descend obliquely downward and forward. 

Inserted into the lateral surface of the tendon of the 
rectus cruris, and into the side of the patella. 

Situation. This muscle embraces the inside of the 
femur in the same manner as the last described muscle 
does the outside, but it is much smaller ; — it is also in 
part covered by the rectus. At its upper part the sar- 
torius passes over it obliquely. 

Use. Same as the last. 

6. The Crur^eus, or Cruralis — Arises, fleshy, from 
between the two trochanters of the os femoris, from all 
the forepart of the bone, and from the outside as far 
back as the linea aspera; but from the inside of the bone 
it does not arise, for between the forepart of the femur 
and the inner edge of the linea aspera, there is a smooth 
plain surface, of the breadth of an inch, extending nearly 
the whole length of the bone, from which no muscular 
fibres arise. 

Inserted into the posterior surface of the tendon of 
the rectus, and upper edge of the patella. 



MUSCLES OF THE THIGH. 181 

Situation. The principal part of this muscle is lapped 
over, and concealed, by the bellies of the two vasti. 
Use. Same as the last. 

7. The Gracilis — Arises, by a broad thin tendon, 
from the lower half of tha-Tpart of the os pubis which forms 
the symphysis, and from the inner edge of the descend- 
ing ramus : it soon grows fleshy, and forms a belly, 
which, becoming narrower as it descends, terminates in 
a tendon, which passes behind the inner condyle of the 
thigh-bone, and is reflected forward, to be 

Inserted in the inside of the tibia. 

Situation. From the pubis to the knee it runs imme- 
diately under the integuments on the inside of the thigh; 
it is inserted below the tendon of the sartorius, and above 
that of the semitendinosus. 

Use. To bring the taigh inward and forward, and to 
assist in bending the leg. 

8. The Pectinalis — Arises, fleshy, from that ridge 
of the os pubis which forms the brim of the pelvis, and 
from the concave surface below the ridge: it forms a 
thick flat belly. * 

Inserted, by a flat tendon into the linea aspera, im- 
mediately below the lesser trochanter. 

Situation. Its origin lies on the inside of the belly of 
the psoas magnus, where that muscle slides over the 
brim of the pelvis, and on the outside of the origin of 
the adductor longus. 

Use. To bend the thigh forward, to move it inward, 
and to perform rotation, by turning the toes outward. 

9. The Triceps Adductor Femoris consists of three 
distinct muscles, which, passing from the pelvis to the 
thigh, lie in different layers upon one another, and have 
nearly the same action. 

(1) The Adductor Longus — Arises, by a short strong 
tendon, from the upper and inner part of the os pubis, 
near its symphysis; — forms a large triangular belly, 
which, as it descends, becomes broader, but less thick. 

Inserted, tendinous, into the middle part of the linea 
aspera : from its tendon and that of the vastus internus, 
a membranous canal is formed for the femoral artery. 



182 



PRACTICAL ANATOMY. 



The Anastomotica Magna Artery is given off here 
also. 

Fig. 58. 
Another View of the Adductor Muscles with the Pectineus. 




1. Upper Part of Adductor Magnus. 

2. Pectineus. 

3. Adductor Longus. 

4. Adductor Magnus. 

5, 6. Foramina for the First and Second Per- 
forating Arteries. 

7, 8. Foramina for the Femoro-popliteal Ves- 
sels. 



Situation. It arises betwixt the pectinalis and gracilis, 
and above the adductor brevis. 

(2) The Adductor Brevis — Arises, fleshy and ten- 
dinous, from the os pubis, between the lower part of the 
symphysis pubis, and the foramen thyroideum ; — -it forms 
a fleshy belly. 

Inserted, tendinous, into the upper third of the linea 
aspera. 

Situation. Its origin lies under the origins of the pecti- 
nalis and adductor longus, and on the outside of the 
tendon of the gracilis. It is inserted behind those 
muscles, but before the adductor magnus. The obturator 
nerve lies upon it after coming through the obturator 
foramen, with an artery of the same name. 



MUSCLES OF THE THIGH. 



183 



Fig. 59. 
Adductor Muscles, with the Obturator Externus. 



1 


Femur. 


2. 


Ilium. 


3! 


Pubis. 


4. 


Obturator Externus. 


5. 


Superior Fasciculus of the Ad- 




ductor Magnus. 


6, 7. 


Adductor Brevis 


8. 


Adductor Longus 


9, 10. 


Adductor Magnus. 


11. 


Foramen for the Passage of the 




Perforating Arteries. 


12. 


Same for Femoro-popliteal Ves- 




sels. 




(3) The Adductor Magnus — Arises, principally 
fleshy, from the lower part of the body, and from the 
descending ramus of the os pubis, and from the ascend- 
ing ramus of the ischium, as far as the tuberosity of that 
bone. The fibres run outward and downward, having 
various degrees of obliquity. 

Inserted, fleshy, into the whole length of the linea 
aspera, into the oblique ridge above the internal condyle 
of the os femoris, and, by a roundish long tendon, into 
the upper part of that condyle. 

Situation, This large muscle arises behind and below 
the two other adductors; it forms a flat partition be- 



184 PRACTICAL ANATOMY. 

twixt the muscles on the fore and back parts of the 
thigh. 

Use. To approximate the thighs to each other; — to 
roll them outward. 

Arteries, Veins, and Nerves on the Forepart and Inside 
of the Thigh. 

1. Arteries. 

The Femoral Artery may be said to pass along the 
inside of the thigh, where it emerges from under Poupart's 
ligament ; it lies cushioned on the fibres of the psoas 
magnus, is called the inguinal artery, and is very nearly 
in the mid space between the angle of the pubis and the 
anterior superior spine of the ilium, nearer however by 
a finger's breadth to the former; having left the groin, it 
assumes the name of Femoral, and in its course down the 
thigh, runs over the following muscles: the pectinalis, 
part of the adductor brevis ; the whole of the adductor 
longus, and about an inch of the adductor magnus ; it 
then slips betwixt the tendon of the adductor magnus and 
the bone, and, entering the ham, becomes the Popliteal 
artery. There is a strong interlacing of the tendinous 
fibres, forming a deep groove for the artery between the 
adductor longus and vastus internus. The artery is ac- 
companied by the Femoral vein, first inside, and then 
gradually getting behind it. The long saphenous nerves 
and short saphenous nerves accompany the vessels, as 
will presently be seen. It is also invested by a firm 
sheath, which consists of condensed cellular membrane, 
intermixed with some tendinous fibres : for some inches 
below Poupart's ligament, this artery is on its forepart 
only covered by cellular substance, absorbent glands, and 
the general fascia of the thigh; but, meeting with the 
inclined line of the sartorius, it is, during the rest of its 
course, covered by that muscle. It perforates the tendon 
of the adductor magnus, at the distance of rather more 
than one-third of the length of the bone from its lower 
extremity. 

Branches of the Femoral Artery. — The A. Pro- 
funda comes off from the femoral artery at the distance 



ARTERIES OF THE THIGH. 



185 



of two or three inches from Poupart's ligament ; it is 
nearly as large as the femoral itself, runs down for some 
little way behind it, and terminates in three or four 

Fig. 60. 
Arteries seen on the Front of the Thigh. 



1, 2. Femoral Artery. 

3. Superficial Epigastric, cut off. 

4, 4. External Pudics, cut off. 

5, 5. Profunda Femoris. 

6. Internal Circumflex. 

7. External Circumflex. 
8, 8. Perforating Arteries. 

9. Epigastric. 

10. Circumflexa Ilii. 

11. Muscular Branch. 

12. Superior Internal Articular Ar- 

tery. 

13. One of its Branches. The Pop- 

liteal Artery begins where the 
Femoral terminates, at 2. 




branches, which, perforating the triceps adductor, are 
named Arterle Perforantes. These supply the great 
mass of muscles on the back part of the thigh, and inos- 
culate largely with the sciatic, gluteal, and obturator 
arteries. The profunda also sends off two considerable 
branches (the first ones), which, encircling the upper 
part of the thigh, are named Circumflexa Interna, 
and Circumflexa Externa. 

The small branches of the femoral artery before the 
profunda may be enumerated as follows: 1. Some twigs 

9* 



186 PRACTICAL ANATOMY. 

to the inguinal glands {inguinal)] 2. Some to the ex- 
ternal parts of generation, named Pudicae Externae ; 
3. One or two going toward the anterior superior spinous 
process of the ilium (Superficial Circumflex Ilii); 4. 
One upward over the fascia of the abdomen, Superfi- 
cial Epigastric, or arteria ad cutem abdominis. 

The Obturator Artery, arteria obturatrix, which 
is a branch of the internal iliac artery, passes through 
the notch at the upper part of the foramen thyroideum, 
and ramifies on the deep-seated muscles at the upper 
and inner part of the thigh. 

2. Veins. 

The Femoral Vein adheres closely to the femoral 
artery in its passage out of the abdomen, and accom- 
panies it in its course down the thigh, where it passes 
under Poupart's ligament; it lies on the inside of the 
artery, but, as it descends, it turns more and more pos- 
teriorly, so that where they perforate the tendon of 
the adductor magnus, the vein is situated fairly behind 
the artery. 

Its branches correspond to those of the femoral artery; 
but about an inch below Poupart's ligament, it receives 
the vena saphena major, to which there is no correspond- 
ing artery. 

The Obturator Vein accompanies the obturator 
artery, and has the same distribution. 

3. Nerves. 

Femoral nerve, Nervus Cruralis Anterior, or the 
Anterior Crural nerve, where it passes from under Pou- 
part's ligament, lies about half an inch on the outside of 
the femoral artery ; it immediately divides into a num- 
ber of branches, which supply the muscles and integu- 
ments on the forepart and outside of the thigh : a con- 
siderable branch, however, accompanies the femoral 
artery, leaves that vessel where it is about to perforate 
the adductor magnus, and appears as a cutaneous nerve 
on the inside of the knee ; proceeding downward on the 
inside of the leg, it accompanies the saphena vein, and 



DISSECTION OF THE LEG AND FOOT. 187 

terminates on the inner ankle, and upper part of the 
foot. This branch is named Nervus Saphenus Longus. 

Another branch, which, running close to the femoral 
vessels, pierces the fascia, and is distributed below the 
knee. The Short Saphenous. 

Middle Cutaneous to the sartorius and skin. 

Muscular to muscles principally on the outer side of 
the thigh. 

Nervus Obturator, or the obturator nerve, is found 
accompanying the obturator artery and vein ; it has the 
same distribution, and some branches extend as far as 
the internal condyle of the thigh-bone, and communicate 
with the nervus saphenus. 

Dissection of the Forepart of the Leg and Foot. 

Carry an incision from the tubercle of the tibia along 
its spine, over the dorsum of the foot to the toes, where 
it may be crossed by a second from the inside to the 
outside of the foot. Reflect the integuments. The skin 
must be dissected off the toes separately. The fascia 
covering the muscles on the front of the leg is very 
strong. It is fixed to the heads of the tibia and fibula, 
is strengthened by a contribution from the Fascia Lata 
Femoris, and by its deep surface gives origin, in part, 
to the muscles. At the ankle it becomes very strong, 
and adhering to the outer and inner malleolus,. forms the 
Annular Ligament which binds down the tendons. 
Before removing this fascia, notice the Saphena In- 
terna Vein and Nerve, running along the inside of 
the leg, and over the ankle to the foot, and around the 
external malleolus. The Saphena externa vein and 
nerve to the outer part of the foot, and over the outer 
ankle filaments of the peroneal cutaneous nerve (from 
the Peroneal). 

The fascia should then be dissected off, and, in doing 
this, remark that it sends down processes betwixt the 
muscles; these are named intermuscular ligaments ; they 
give origin to the fibres of all the muscles betwixt which 
they pass, connecting them together inseparably, so that 
the dissection has a rough appearance. 



188 PRACTICAL ANATOMY, 



Muscles situated on the Forepart and Outside of the Leg. 

These are six in number. 

1. The Tibialis Anticus — Arises, principally fleshy, 
from the exterior surface of the tibia, from its anterior 
angle or spine, and from nearly half of the interosseous 
ligament, and two-thirds of the length of the bone; also 
from the inner surface of the fascia of the leg, and from 
the intermuscular ligaments. The fleshy fibres descend 
obliquely, and terminate in a strong tendon, which 
crosses from the outside to the forepart of the tibia, 
passes through a distinct ring of the annular ligament 
near the inner ankle, runs over the astragalus and os 
naviculare, and is 

Inserted into the upper and inner part of the os cunei- 
forme internum, and the base of the metatarsal bone 
supporting the great toe. 

Situation. The belly is quite superficial, lying under 
the fascia of the leg on the outside of the spine of the 
tibia. 

Use. To draw the foot upward and inward; or, in 
other words, to bend the ankle-joint. 

2. Extensor Longus Digitorum Pedis — Arises, 
tendinous and fleshy, from the outer part of the head of 
the tibia ; from the head of the fibula; from the anterior 
angle of the fibula almost its whole length, and from 
part of the smooth surface between the anterior and in- 
ternal angles; from a small part of the interosseous 
ligament; from the fascia and intermuscular ligaments. 

Below the middle of the leg, it splits into four round 
tendons, which pass under the annular ligament, become 
flattened, and are 

Inserted into the root of the first phalanx of each of 
the four small toes, and expanded over the upper side of 
the toes as far as the root of the last phalanx. 

Situation. This muscle also runs entirely superficial; 
it lies between the tibialis anticus and peroneus longus, 
but at the lower part of the leg it is separated from the 
tibialis anticus by the extensor pollicis longus. 



MUSCLES OF THE LEG AND FOOT. 189 

Use. To extend all the joints of the four small toes : 
to bend the ankle-joint. 

3. Peroneus Tertius — Arises, fleshy, from the an- 
terior angle of the fibula, and from part of the smooth 
surface between the anterior and internal angles, ex- 
tending from below the middle of the bone downward to 
near its inferior extremity; sends its fleshy fibres for- 
ward to a tendon, which passes under the annular liga- 
ment, in the same sheath as the extensor digitorum 
longus, and is 

Inserted into the base of the metatarsal bone of the 
little toe. 

Situation. The belly is inseparably connected with 
the extensor longus digitorum, and is properly the outer 
part of it. 

Use. To assist in bending the foot. 

4. Extensor Proprius Pollicis Pedis — Arises, 
tendinous and fleshy, from part of the smooth surface 
between the anterior and internal angles of the fibula, 
and from the neighboring part of the interosseous liga- 
ment, extending from some distance below the head of 
the bone to near its inferior extremity ; the fibres pass 
obliquely downward and forward into a tendon, which, 
inclining inward, passes over the forepart of the astraga- 
lus and os naviculare, to be 

Inserted into the base of the first and of the second 
phalanges of the great toe. 

Situation. The belly is concealed between the tibialis 
anticus and extensor digitorum longus, and cannot be seen 
till those muscles are separated from one another. 

Use. To extend the great toe; and to bend the ankle. 

The anterior tibial artery and nerve will be seen at 
the upper third of the limb between the extensor com- 
munis of the toes and the tibialis anticus, at the middle 
between the last and the extensor pollicis, and at the 
ankle between the last and the extensor communis digi- 
torum. Branches will be described presently. 

5. The Peroneus Lonqus — Arises, tendinous and 
fleshy, from the forepart and outside of the head of the 
fibula, and from the adjacent part of the tibia, from the 



190 



PRACTICAL ANATOMY. 



Fig. 61. 
A Side View of the Muscles oe the Leg and Foot. 




1. 


Biceps Flexor Cruris. 


2. 


Vastus Exteruas. 


3, 3. 


Gastrocnemius. 


4. 


Soleus. 


5. 


Tendo Achillis. 


6. 


Tibialis Anticus. 


7. 


Extensor Longus Digito 




rum Pedis. 


8. 


Extensor Proprius Poi- 




nds. 


9. 


Peroneus Tertius. 


10. 


Peroneus Longus. 


11. 


Peroneus Brevis. 


12, 12. 


Abductor Minimi Digiti. 


13. 


Extensor Brevis Digito- 




rum. 


14. 


Interosseus Dorsalis. 



-7272*0 13 U J2 i4!2 12 



external angle of the fibula, and from the smooth surface 
between the anterior and external angles as far down as 
one-third of the length of the bone from its lower ex- 
tremity; also from the fascia of the leg and intermuscular 
ligaments. The fibres run obliquely outward into a ten- 
don, which passes behind the outer ankle, through a 
groove in the lower extremity of the fibula ; is then re- 
flected forward through a superficial fossa in the out- 
side of the os calcis, passes over a projection, runs in a 
groove in the os cuboides, passes over the muscles in the 
sole of the foot, and is 

Inserted, tendinous, into the outside of the base of the 
metatarsal bone of the great toe, and into the os cunei- 
forme internum. 



MUSCLES OF THE FOOT. 191 

Situation. The belly is quite superficial; it lies between 
the outer edge of the extensor longus digitorum and the 
anterior edge of the soleus. The tendon is superficial 
where it crosses the outside of the os calcis, but, in the 
sole of the foot, is concealed by the muscles situated 
there, and will be seen in the dissection of that part. 

Use. To extend the ankle-joint, turning the sole of 
the foot outward. 

6. The Peroneus Brevis — Arises, fleshy, from the 
outer edge of the anterior angle of the fibula, and from 
part of the smooth surface behind that angle; beginning 
about one-third down the bone, and continuing its adhe- 
sion to near the ankle ; from the fascia of the leg, and 
from the intermuscular ligaments. The fibres run ob- 
liquely toward a tendon, which passes through a groove 
of the fibula behind the outer ankle, being there inclosed 
in the same ligament with the tendon of the peroneus 
longus, then through a separate groove on the outside of 
the os calcis, and is 

Inserted into the external part of the base of the 
metatarsal bone that sustains the little toe. 

Situation. This muscle arises between the extensor 
longus digitorum and peroneus longus ; its belly is over- 
lapped, and concealed by the belly of the peroneus 
longus. 

Below it is separated from the peroneus tertius by 
that projection of the fibula which forms the outer ankle, 
and which is only covered by the common integuments. 

Use. Same as that of the peroneus longus. 

Muscles on the Upper Part of the Foot. 

Only one muscle is found in this situation. 

Extensor Brevis Digitorum Pedis — Arises, fleshy 
and tendinous, from the anterior and upper part of the 
os calcis, from the os cuboides, and from the astragalus ; 
forms a fleshy belly, divisible into four portions ; these 
send off four slender tendons, which are 

Inserted, the first tendon into the first phalanx of the 
great toe, and the other three into all the small toes ex- 



192 PRACTICAL ANATOMY. , 

cept the little one, uniting with the tendons of the ex- 
tensor digitorum longus, and being attached to the upper 
convex surface of all the phalanges. 

Situation. The belly of this muscle lies under the 
tendons of the extensor digitorum longus and peroneus 
brevis. 

Use. To extend the toes. 

Of the Vessels and ^Nerves in the Forepart of the Leg 
and Foot. 

1. Arteries. 

Arteria Tibialis Antica. — The anterior tibial ar- 
tery passes from the ham betwixt the inferior edge of 
the popliteus and the superior fibres of the soleus, and 
then through a large perforation in the interosseous lig- 
ament, to reach the forepart of the leg ; this perforation 
is much larger than the size of the artery, and is filled 
up by the fibres of the musculus tibialis posticus, which 
may thus be said to arise from the forepart of the tibia. 
The artery then runs down close upon the middle of the 
interosseous ligament, between the tibialis anticus and 
extensor proprius pollicis ; below the middle of the leg 
it leaves the interosseous ligament, and passes gradually 
more forward ; it crosses under the tendon of the exten- 
sor proprius pollicis, and is then situated between that 
tendon and the first tendon of the extensor longus digi- 
torum. At the ankle it runs over the forepart of the 
tibia, being now situated more superficially; then over 
the astragalus and os naviculare, and over the junction 
of the os cuneiforme internum and medium, crossing 
under that tendon of the extensor brevis digitorum which 
goes to the great toe. Arriving at the space between 
the bases of the two first metatarsal bones, it plunges 
into the sole of the foot, and immediately joins the 
plantar arch. 

Branches. — 1. A. Recurrens, which ramifies over 
the forepart of the knee, inosculating with the articular 
arteries. 

2. Numerous twigs to the tibialis anticus, extensor 
pollicis, and other muscles on the forepart of the leg. 



ARTERIES OF THE LEG AND FOOT. 



193 



3. A. Malleolaris Interna ramifies over the inner 
ankle, and inosculates with the peroneal and posterior 
tibial arteries. 

4. The External Malleolar ramifies over the outer 
ankle. 

Fig. 62. 

A View of the Anterior Tibial Artery. 



1. Tendon of the Rectus Muscle. 

2. Ligament of the Patella. 

3. Tibia. 

4. Extensor Proprius Pollicis Pedis. 

5. Extensor Communis Digitorum Pedis. 

6. Peroneus Longus and Brevis Muscles. 

7. Inner Border of the Gastrocnemius and 

Soleus Muscles. 

8. Anterior Annular Ligament. 

9. Anterior Tibial Artery. 

10. Recurrent Articular Branch. 

11. Internal Malleolar Branch. 

12. Anterior Peroneal Artery. 

13. Dorsal Artery of the Great Toe. 

14. Tarsal and Metatarsal Branches. 

15. Branch to the Great Toe. 

16. Terminal Branch to join the Plantar 

Arch. 

17. External Malleolar Artery. 



5. The Tarsal and Metatarsal Arteries are two 
small branches which cross the tarsal and metatarsal 
bones, and pass obliquely to the outer edge of the foot. 

From the tarsal or metatarsal artery come off the In- 



194 PRACTICAL ANATOMY. 

terosseal Arteries, which supply the interosseal 
spaces and the back part of the toes. 

6. A large branch comes off from the anterior tibial, 
where it is about to plunge into the sole of the foot ; it 
runs along the space betwixt the two first metatarsal 
bones, and at the anterior extremity of those bones bi- 
furcates into — 

(1) A. Dorsalis Hallucis, a considerable branch, 
which runs on the back part of the great toe. 

(2) A branch which runs on the inner edge of the 
toe next to the great one. 

2. Veins. 

The Anterior Tibial Vein consists of two branches, 
which accompany the artery and its ramifications. 

3. Nerves. 

The Anterior Tibial Nerve is a branch of the pe- 
roneal nerve; it is seen in the ham arising from the pero- 
neal and crossing under the muscles on the outside of the 
fibula; it emerges from under the extensor longus digi- 
torum, comes in contact with the anterior tibial artery, 
and accompanies it down the leg; it is distributed on the 
back part of the foot and toes. 

Posterior Part of the Thigh. 

Above that part of the fascia which invests the thigh 
behind there are several cutaneous nerves. They 
originate either from the lumbar nerves and come over 
the spine of the ilium, or from the great sciatic nerve 
emerging under the edge of the gluteus maximus. Other 
twigs come from the sacral nerves or the sciatic as it passes 
doivn the thigh. 

Muscles on the Back Part of the Thigh. 

There are eleven. Carry an incision along the crest 
of the ilium to the spine, thence over the sacrum to the 
point of the os coccygis. Reflect the integuments. 



POSTERIOR PART OF THE THIGH. 195 

Gluteus Maximus — Is usually covered by a large 
amount of adipose substance. It arises, fleshy, from the 
posterior third of the crest of the ilium, from the whole 
lateral surface of the sacrum below the posterior spinous 
process, from the back part of the inferior sacro-sciatic 
ligament, over which the muscle projects, and from the 
side of the os coccygis. The fibres converge to form a 
strong flat tendon, which glides over the trochanter major, 
is connected to the fascia lata, and is 

Inserted into the rough surface on the outer part of 
the linea aspera immediately below the trochanter. 

Situation. It is quite superficial, covering all the other 
muscles which are situated on the back part of the hip, 
covering also the tuber ischii, and the tendons of the 
muscles which arise from that projection. Its insertion 
lies between the vastus externus and the adductor mag- 
nus femoris. 

Use. To restore the thigh, after it has been bent; to 
rotate it outward; to extend the pelvis on the thigh, and 
maintain it in that position in the erect posture of the 
body. 

The muscle is now to be lifted from its origin, and left 
hanging by its tendon; remark the large bursa mucosa 
formed between the tendon and the trochanter major. 

2. The Gluteus Medius — Arises, fleshy, from all the 
outer edge of the spine of the os ilium, as far as the 
posterior tuberosity; from the dorsum of the bone, 
between the spine, and semicircular ridge; also from 
the rough surface which extends from the anterior supe- 
rior to the anterior inferior spinous process, and from 
the inside of a fascia which covers its anterior part. 
The fibres converge into a strong and broad tendon, 
which is 

Inserted into the upper and outer part of the great 
trochanter. 

Situation. The posterior part of the belly and the 
tendon are concealed by the gluteus maximus, but the 
anterior and largest part of this muscle is superficial, 
being covered by a strong fascia. 

Use. To draw the thigh-bone outward, or away from 



196 



PRACTICAL ANATOMY. 



the opposite limb ; to maintain the pelvis in a state of 
equilibrium on the thigh in progression, while the other 
foot is raised from the ground; by its posterior fibres to 
rotate the limb outward; and by its anterior inward. 

Having lifted up this muscle from its origin, you will 
discover 

Fig. 63. 




A View of the Gluteus Minimus Muscle. 

3. The Gluteus Minimus. — It arises, fleshy, from 
the semicircular ridge of the ilium, and from the dorsum 
of the bone below the ridge within half an inch of the 
acetabulum. Its fibres run in a radial direction toward 
a strong tendon, which is 

Inserted into the anterior and superior part of the 
great trochanter. 

Situation. It is entirely concealed by the gluteus 
medius. 

Use. Same as that of the preceding. 

4. The Pyriformis — Arises, within the pelvis, by 
three tendinous and fleshy origins, from the second, 
third, and fourth false vertebra or divisions of the 
sacrum. It forms a thick belly, which passes out of the 
pelvis through the great sacro-ischiatic foramen above 
the superior sacro-sciatic ligament. 



POSTERIOR PART OF THE THIGH. 197 

Inserted, by a roundish tendon, into the uppermost 
part of the cavity of the root of the trochanter major. 

Situation. Like the other small muscles of the hip, it 
is entirely concealed by the gluteus maximus; its belly 
lies behind and below the gluteus medius. 

Use. To move the thigh a little upward, and roll it 
outward. The great sciatic nerve, the ischiatic and 
internal pudic bloodvessels and nerves, pass out of the 
pelvis below this muscle, and the gluteal bloodvessels 
and nerve above it. 

5. The Gemini consist of two heads, which are dis- 
tinct muscles. 

(1) The superior arises from the back part of the 
spinous process of the ischium. 

(2) The inferior from the upper part of the tuberosity 
of the os ischium, and the anterior surface of the posterior 
sacro-sciatic ligament. 

Inserted, tendinous and fleshy, into the cavity at the 
root of the trochanter major, immediately below the 
insertion of the pyriformis, and above the insertion of 
the obturator externus. 

Situation. Like the other muscles, they are covered 
by the gluteus maximus ; they lie below the pyriformis, 
and above the quadratus femoris. 

Use. To roll the thigh outward, and to bind down 
the tendon of the obturator internus. 

Lying between the bellies of the gemini, you will 
perceive 

6. The Obturator Internus. — It arises, tendinous 
and fleshy, from more than one-half of the internal cir- 
cumference of the foramen thyroideum, and from the 
inner surface of the ligament which fills up that hole ; it 
forms a flattened tendon, which passes out of the pelvis 
in a sinuosity betwixt the spinous process and tuberosity 
of the ischium, and, becoming rounder, is 

Inserted into the pit at the root of the trochanter 
major. 

Situation. Its origin lies within the pelvis, and can- 
not be exposed till the contents of that cavity are re- 
moved; the tendon, where it passes through the notch 



198 



PRACTICAL ANATOMY. 



in the ischium, is seen projecting between the two 
origins of the gemelli. There is a bursa mucosa be- 



Fig. 64. 
A View of the Muscles on the Back of the Hip. 




1, 2. Gluteus Medius. 

3. Cut Origin of Gluteus 

Maximus. 

4. Pyriformis. 
5, 8, 10. Gemelli. 

6, 7. Obturator Internus. 
2. Quadratus Femoris. 



twixt the tendon of this muscle and the -surface of the 
ischium over which it glides. 

Use. To roll the os femoris obliquely outward. 

7. The Quadratus Femoris — Aloises, tendinous and 
fleshy, from an oblique ridge, which descends from the 
inferior edge -of the acetabulum along the body of the 
ischium, between its tuberosity and the foramen thyroid- 
eum ; its fibres run transversely, to be 

Inserted, fleshy, into a rough ridge on the back part 
of the femur, extending from the root of the greater 
trochanter to the root of the lesser. 

Situation. It is concealed by the gluteus maximus; its 
origin is in contact with the origin of the hamstring 
muscles. 

Use. To roll the thigh outward. 



POSTERIOR PART OF THE THIGH. 199 

On lifting up the quadratus femoris from its origin, 
and leaving it suspended by its insertion, you discover, 
running in the same direction, the strong tendon of 

8. The Obturator Externus. — This muscle arises, 
fleshy, from almost the whole circumference of the fora- 
men thyroideum, and from the external surface of the 
obturator ligament ; its fibres pass outward through the 
notch placed between the inferior margin of the acetab- 
ulum and the tuberosity of the ischium, wind around 
the cervix of the os femoris, adhering to the capsular 
ligament, and terminate in a strong tendon, which is 

Inserted into the lowermost part of the cavity, at the 
root of the trochanter major, immediately below the in- 
sertion of the inferior head of the gemini. 

Situation, This muscle cannot be distinctly seen, until 
all the muscles which run from the pelvis to the upper 
part of the thigh are removed, both on the fore and 
back part. 

Use. To roll the thigh-bone obliquely outward. 

9. The Biceps Flexor Cruris — Arises by two dis- 
tinct heads : the first, called the Long Head, arises in 
common with the semitendinosus, by a short tendon, 
from the outer part of the tuberosity of the ischium, 
and, descending, forms a thick fleshy belly. The second, 
termed the Short Head, arises, tendinous and fleshy, 
from the linea aspera, immediately below the insertion 
of the gluteus maximus ; and from the oblique ridge 
running to the outer condyle, where it is connected with 
the fibres of the vastus externus. The two heads unite 
at an acute angle, a little above the external condyle, 
and terminate in a strong tendon, which is 

Inserted into a rough surface on the outside of the 
head of the fibula. 

Situation. The long head of this muscle is concealed 
at its upper part by the inferior fibres of the gluteus 
maximus ; below this, it is situated quite superficial, — 
it forms the outer hamstring. 

Use. To bend the leg, and particularly by means of 
its shorter head to twist the leg outward in the bent 
state of the knee. 



200 



PRACTICAL ANATOMY. 



10. The Semitendinosus — Arises, tendinous, in com- 
mon with the long head of the biceps, from the tuber- 
osity of the ischium ; it has also some fleshy fibres arising 
from that projection more outwardly: as it descends, it 
arises for two or three inches, fleshy, from the inside of 
the tendon of the biceps ; forms a thick belly, and term- 
Fig. 65. 
A View of the Principal Muscles of the Back of the Thigh. 




1. Gluteus Medius. 

2. Gluteus Maximus. 

3. Biceps Flexor Cruris. 

4. Tendon of Semitendinosus. 

5. Semimembranosus Muscle. 

6. Semitendinosus Muscle. 



inates at the distance of three or four inches from the 
knee in a long round tendon, which, becoming flat, 
passes behind the head of the tibia, and is reflected for- 
ward, to be 



POSTERIOR PART OF THE THIGH. 201 

Inserted into the anterior angle of that bone, some 
little way below its tubercle. 

Situation. This muscle, as well as the biceps, is cov- 
ered above by the gluteus maximus ; its belly lies be- 
tween the biceps flexor and gracilis, and is situated 
entirely superficial. 

Use. To bend the leg backward, and a little inward. 

11. The Semimembranosus — Arises, by a strong 
round tendon, from the upper and outer part of the 
tuberosity of the ischium ; the tendon, soon becoming 
broader, sends off obliquely a fleshy belly ; this muscle 
is continued, fleshy, much lower down than that last de- 
scribed. The fleshy fibres terminate obliquely in another 
flat tendon, which passes behind the inner condyle, sends 
off a thin aponeurotic expansion under the inner head of 
the gastrocnemius, to cover the posterior part of the 
capsule of the knee-joint, and to be affixed to the ex- 
ternal condyle: the tendon then becoming rounder, is 

Inserted into the inner and back part of the head of 
the tibia. 

Situation. This is a semipenniform muscle ; its origin 
lies anterior to the tendinous origin of the two last mus- 
cles, and more outwardly, being situated between them 
and the origin of the quadratus femoris. 

Use. To bend the leg backward. 

The two last described muscles properly form the 
inner hamstring; but some enumerate among the tendons 
of the inner hamstring, the sartorius and gracilis. 

Vessels and Nerves on the Posterior Part of the Thigh. 

Arteries. 

1. Arteria Glutea, or Iliaca Posterior. — This is 
the largest branch of the internal iliac artery ; it passes 
out of the pelvis at the upper part of the sciatic notch. 
On raising the gluteus maximus, and medius, this artery 
is seen coming over the pyriformis, betwixt the superior 
edge of that muscle and the inferior edge of the os ilium. 
The principal trunk passes under the gluteus medius, 
and ramifies on the dorsum of the os ilium ; other large 

10 



202 PRACTICAL ANATOMY. 

branches are also continued to the gluteus maxiums, 
and the muscles situated on the back part of the pelvis. 

2. Arteria Sciatica, vel Ischiatica, is another large 
branch of the internal iliac, which comes out from under 
the pyriformis, betwixt the lower edge of that muscle 
and the superior sacro-sciatic ligament ; its principal 
branches descend between the trochanter major and 
tuberosity of the ischium ; it sends other twigs round 
toward the anus and perineum. 

Both these arteries inosculate with the other branches 
of the internal and external iliac. 

The Internal Pudic, a branch of the ischiatic, within 
the pelvis, comes out below the pyriformis, and re-enters 
the pelvis through the lesser ischiatic opening, and con- 
tinuing up along the ramus of the ischium and pubes, is 
ultimately distributed to the penis. 

The Veins correspond exactly to the arteries. They 
terminate in the internal iliac vein. 

Nerves. 

Nervus Sciaticus, vel Ischiaticus, or the Great 
Sciatic Nerve, from the sacral plexus, is seen coming 
out of the pelvis, below the pyriformis. It descends 
over the gemini and quadratus femoris in the hollow 
betwixt the great trochanter and the tuberosity of the 
ischium — runs down the back part of the thigh, anterior 
to, i.e. nearer the bone than the hamstring muscles; 
being situated between the anterior surface of the semi- 
membranosus and the posterior surface of the triceps 
adductor longus. After sending off the peroneal nerve, 
it arrives in the ham, and becomes the Popliteal 
Nerve. In this course it gives off several branches to 
the muscles and integuments. It sometimes perforates 
the belly of the pyriformis by 'distinct trunks, which 
afterward unite. 

Gluteal Nerve, derived from the fifth lumbar nerve, 
and accompanying the Gluteal Artery. 

Internal Pudic Nerve, derived from the sacral 
plexus, and follows the course of Internal Pudic Artery 
and its branches. 



BACK PART OF THE THIGH. 203 

Lesser Ischiatic — from the sacral plexus : passes out 
below the pyriformis, and passes down the thigh to the 
ham, where it becomes connected with the external 
saphenous nerve. Its branches are muscular and cuta- 
neous ; to the gluteus maximus integuments of the hip, 
etc. One branch, the Inferior Pudendal, curves around 
the tuber ischii, and is distributed to the scrotum. 

Dissection of the Ham and Fascia on the Back Part of 
the Thigh. 

On removing the integuments from the back part of 
the knee-joint and leg, we observe a Fascia, which 
covers the great vessels and muscles. It is evidently 
continued from the great fascia of the thigh, is strength- 
ened by adhesions to the condyles of the femur, and to 
the head of the fibula, and is prolonged upon the mus- 
cles on the back of the leg. 

Upon dissecting back that part of the fascia which 
covers the ham, the Great Sciatic Nerve appears 
lying between the outer and inner hamstring muscles. 
This nerve, having given off branches about the ham, 
and to the integuments on the back of the leg, divides 
at some distance above the condyles of the femur into 
two large branches. 

1. The greater Nerve continues its course betwixt 
the heads of the gastrocnemii muscles. In the ham it 
is named the Popliteal Nerve, and where it descends 
in the leg, Posterior Tibial. 

2. The lesser Nerve, which is the external branch, is 
named the Peroneal or Fibular Nerve; it passes 
outward and obliquely downward, runs between the 
external head of the gastrocnemius, and the tendon of 
the biceps flexor cruris ; and sinks among the muscles 
which surround the head of the fibula. 

Branches of the Peroneal Nerve. 

(1) Cutaneous branches are sent off from the peroneal 
nerve at its uppermost part over the gastrocnemius to 
the integuments in the back part of the leg, and outer 



PRACTICAL ANATOMY. 



a 



Fig. 66. 
A View of the Greater and Lesser 
Sciatic Nerves in their entire 
Course down the Limb. 



1. Superior Gluteal Nerve. 

2. Pudic Nerves. 

3. Lesser Sciatic Nerve. 

5. Inferior Pudendal Branch. 

6. Continuation of the Small Sci- 

atic. 

7. Greater Sciatic Nerve. 

8, 9. Popliteal, and Posterior Tibial 
Nerve. 
10, 12. Short Saphenous Nerve. 

11. Peroneal Communicating Branch. 
13. Peroneal Nerve. 



BACK PART OF THE THIGH. 205 

side of the foot. Branches also are distributed about 
the joint. 

(2) A large branch, the Anterior Tibial Nerve, 
passes under the flesh of the peroneus longus and ex- 
tensor longus digitorum, where those muscles arise from 
the heads of the fibula and tibia; and comes in contact 
with the anterior tibial artery, which it accompanies 
down the leg. 

(3) Another branch passes into the upper extremity 
of the peroneus longus, and is continued in the sub- 
stance of that muscle for some space. It then emerges 
from beneath it, and continues its course under the 
muscles on the forepart and outside of the leg ; it 
pierces the fascia, and, becoming cutaneous, is lost on 
the ankle and upper surface of the foot. (The Peroneal 
Cutaneous.) 

Below the great sciatic nerve, there is much cellular 
membrane and fat, which being removed, the Great 
Popliteal Vein is exposed. It adheres to the Pop- 
liteal Artery, which lies under it close upon the 
bone. 

Arteria Poplitea is the trunk of the Femoral, 
which assumes that name, after it has perforated the 
tendon of the adductor magnus. It lies between the 
condyles of the femur, close upon the bone, and descends 
between the heads of the gastrocnemius. At the lower 
edge of the popliteus, the popliteal artery divides into 
the Anterior and Posterior Tibial Arteries. 

Branches. — 1. Articular Arteries are four or 
five small twigs, ramifying over the knee-joint and 
neighboring muscles, inosculating with one another, and 
with the arteries below the knee. 

2. Two branches are sent to the two heads of the 
gastrocnemii muscles ; the sural twigs are also given to 
the soleus, plantaris, etc. 

The Popliteal Vein receives branches correspond- 
ing to those of the artery; it lies behind the artery in 
the erect posture. 

About two inches above the condyle, it receives the 
Vena Saphena Minor, which returns the blood from 



206 PRACTICAL ANATOMY. 

the outer side of the foot ; the trunk of this vein lies 
under the fascia on the back of the leg. 

Dissection of the Posterior Part of the Leg. 

The fascia investing the posterior part of the leg is 
much thinner than on the front part. Remove it and the 
muscles on this aspect of the limb may be exposed. 

They are seven in number. 

1. Gastrocnemius — Arises, by two heads, from the 
upper and back part of the condyles of the os femoris. 
Each head forms a fleshy belly, the fibres of which are 
oblique, passing from a tendinous expansion which covers 
the posterior surface of the muscle to another which 
covers the anterior surface. The internal belly is the 
largest, and they are separated by a triangular interval, 
in which the popliteal bloodvessels and nerves pass to 
the leg. These heads unite a little below the knee, in a 
middle tendinous line, and below the middle of the tibia 
ends in a strong flat tendon which joins that of the 
soleus. In the groove on its surface lies the saphena 
externa nerve and vein. 

Reflect the two heads of the gastrocnemius from the 
femoral condyles, and you will then expose 

2. The Soleus, or Gastrocnemius Internus — which 
arises by two origins or heads. The first, or External 
Origin, which is by much the largest, arises, principally 
fleshy, from the posterior surface of the head of the fibula, 
and from the external angle of that bone, for two-thirds 
of its length, immediately behind the peroneus longus. 
The second, or internal head, arises, fleshy, from an ob- 
lique ridge on the posterior surface of the tibia, just below 
the popliteus, and from the inner angle of that bone, 
during the middle third of its length. The two heads, 
which are separated at first by the posterior tibial artery 
and nerve, unite immediately, form a large belly, which, 
covered by the tendon of the gastrocnemius, is continued, 
fleshy, to within a short distance of the ankle-joint; a 
little above which the tendons of the gastrocnemius and 
soleus unite, and form a strong round tendon, named the 



POSTERIOR PART OF THE LEG. 



207 



Tendon Achillis, which slides over the upper and pos- 
terior part of the os calcis, where it is furnished with a 
small bursa mucosa, to be 

Inserted into a rough surface on the back part of that 
bone. 

Situation. The gastrocnemius arises between the ham- 
string tendons. Its belly is superficial, and forms the 
upper or greater calf of the leg. 

Fig. 67. 
The Superficial Muscles or the Posterior Face of the Leg. 



1. The Biceps Muscle forming the Outer Ham- 

string. 

2. The Tendons forming the Inner Hamstring. 

3. The Popliteal Space. 

4. The Gastrocnemius Muscle. 

5. The Soleus. 

6. Tendo Achillis. 

7. The Posterior Tuberosity of the Os Calcis. 

8. The Tendons of the Peroneus Longus and 

Brevis Muscles passing behind the Outer 
Ankle. 

9. The Tendons of the Tibialis Posticus and 

Flexor Longus Digitorum Pedis passing 
into the Foot behind the Inner Ankle. 



The soleus has its largest part concealed by the gastroc- 
nemius, but part of it appears on each side of the belly 
of that muscle. There is a bursa mucosa betwixt the 
upper part of the os calcis and the tendo Achillis. 



208 PRACTICAL ANATOMY. 

Use. To elevate the os calcis, and thereby to lift up 
the whole body as a preparatory measure to its being car- 
ried forward in progression ; to carry the leg backward 
on the foot when that is fixed ; the gastrocnemius, from 
its origin in the thigh, also bends the leg on the thigh. 

The heads of the gastrocnemius should now be lifted 
up, which will expose 

3. The Plantaris. — This muscle arises, fleshy, from 
the upper part of the external condyle, and from the ob- 
lique ridge above that condyle, forms a pyramidal belly 
about three inches in length, which adheres to the cap- 
sule of the knee-joint, runs over the popliteus, and term- 
inates in a long, slender, thin tendon. This tendon 
passes obliquely inward over the inner head of the soleus, 
and under the gastrocnemius; emerges from between 
those two muscles, where their tendons unite, and then 
runs down by the inside of the tendo Achillis, to be 

Inserted into the posterior part of the os calcis, on 
the inside of the insertion of the tendo Achillis, and 
somewhat before it. 

Situation. The origin and belly of this muscle are 
concealed by the external head of the gastrocnemius. 

Use. To extend the foot and roll it inward, and to 
assist in bending the leg. 

4. The Popliteus — Arises, within the capsular liga- 
ment of the knee, by a round tendon, from a deep pit or 
hollow on the outer side of the external condyle; ad- 
heres to the posterior and outer surface of the external 
semilunar cartilage; passes, within the cavity of the 
joint, over the side of the condyle to its back part; per- 
forates the capsular ligament, and forms a fleshy belly, 
which runs obliquely inward, being covered by a thin 
tendinous fascia, to be 

Inserted, broad, thin, and fleshy, into an oblique ridge 
on the posterior surface of the tibia, a little below its 
head, and into the triangular space above that ridge. 

Situation. This muscle is concealed entirely by the 
gastrocnemius. 

Use. To bend the leg, and, when bent, to roll it, so as 
to turn the toes inward. 



POSTERIOR PART OP THE LEG. 209 

The belly of the soleus should now be lifted, in order 
to expose the deeply-seated muscles. A strong mem- 
branous fascia [Intermuscular) is seen connecting and 
investing them, which is to be removed. This fascia also 
covers the posterior tibial vessels and nerve, but the de- 
scription of the course of these vessels, though seen in 
this stage of the dissection, must be deferred. 

The deep-seated muscles are : 

The Flexor Longus Digitorum Pedis, situated behind 
the tibia. 

The Flexor Longus Pollicis Pedis, situated behind the 
fibula. 

The Tibialis Posticus, which is almost concealed by 
the two other muscles, and by the fascia, which connects 
them, and binds them down. 

5. The Flexor Longus Digitorum Pedis Perfo- 
rans — Arises, fleshy, from the posterior flattened sur- 
face of the tibia, between its internal and external angles, 
below the attachment of the soleus, and continues to 
arise from the bone to within two or three inches of the 
ankle; the fibres pass obliquely into a tendon. This ten- 
don runs behind the inner ankle in a groove of the tibia, 
passes under a strong ligament which goes from the inner 
ankle to the os calcis, and having received a strong ten- 
dinous slip from the flexor pollicis longus, divides about 
the middle of the sole of the foot into four tendons, which 
pass through the slits in the tendon of the flexor digi- 
torum brevis, and are 

Inserted into the extremity of the last joint of the four 
lesser toes. 

The situation of the tendon is described with the mus- 
cles of the foot. 

Use. To bend the last joint of the toes, and to assist 
in extending the foot. 

6. Flexor Longus Pollicis Pedis — Arises, fleshy, 
from the posterior flat surface of the fibula, continuing 
its origin from some distance below the head of the bone 
to within an inch of the ankle. The fleshy fibres term- 
inate in a tendon, which passes behind the inner ankle 
through a groove in the tibia; next through a groove in 

10* 



210 



PRACTICAL ANATOMY. 



the astragalus, crosses in the sole of the foot the tendon 
of the flexor longus digitorum, to which it gives a slip of 
tendon; passes between the two sesamoid bones, and is 

Inserted into the last joint of the great toe. 

Situation. It lies on the outside of the flexor longus 
digitorum, between that muscle and the peroneus longus ; 
the tendon will be seen in the foot. 

Use. To bend the last joint of the great toe, and, 
being connected by a cross slip to the flexor digitorum 
communis, to assist in bending the other toes. 

Fig. 68. 
Deep Muscles on the Back of the Leg. 




The Lower Extremity of the Femur. 

Ligament of Winslow. 

Tendon of the Semimembranous Muscle. 

Internal Lateral Ligament of the Knee-joint. 

External Lateral Ligament. 

Popliteus Muscle. 

Flexor Longus Digitorum Pedis. 

Tibialis Posticus Muscle. 

Flexor Longus Proprius Pollicis Pedis. 

Peroneus Longus Muscle. 

Peroneus Brevis. 

Tendo Achillis divided near its Insertion. 

Tendons of the Tibialis Posticus and Flexor 
Longus Digitorum Pedis, just as they are 
about to pass beneath the Internal Annu- 
lar Ligament. The interval between the 
latter Tendon and the Tendon of the 
Flexor Longus Pollicis is occupied by the 
Posterior Tibial Vessels and Nerves. 



7. The Tibialis Posticus — Arises, fleshy, from the 
posterior surface of both the tibia and fibula, inimedi- 



POSTERIOR PART OF THE LEG. 211 

ately below the upper articulation of these bones with 
each other ; from the whole of the interosseus ligament ; 
from the angles of the bones to which that ligament is 
attached; and from the flat surface of the fibula behind 
its internal angle for more than two-thirds of its length. 
The fibres run obliquely toward a middle tendon, which, 
becoming round, passes behind the inner ankle through 
a groove in the tibia. 

Inserted into the upper and inner part of the os na- 
viculare, being further continued through a groove in 
that bone to the internal and external cuneiform bones. 

Situation. The belly is concealed at its lower part by 
the flexor longus digitorum and flexor pollicis, and can- 
not be seen till those muscles are separated. The ten- 
don crosses under that of the flexor longus digitorum 
above the ankle, and, w T here it passes through the groove 
in the tibia, is situated more forward than the tendon of 
that muscle. 

Use. To extend the foot, and turn it inward. 

Vessels and Nerves of the Posterior Part of the Leg. 
1. Arteries. 

Arteria Tibialis Postica. — The posterior tibial 
artery, which is the continued trunk of the popliteal, 
sinks under the origins of the soleus, and runs down the 
leg between that muscle and the more deeply scattered 
flexors of the toes. It does not lie in immediate con- 
tact with the fibres of the flexors, but, like the femoral 
artery, is invested by a strong sheath of condensed cel- 
lular membrane. It is, together with its veins and ac- 
companying nerve, also supported by the fascia which 
binds down the deep-seated muscles. As it descends, it 
gradually advances more forward, following the course 
of the flexor tendons: it passes behind the inner ankle, 
lying posterior to the tendon of the flexor longus digi- 
torum, and anterior to that of the flexor longus pollicis. 
It sinks under the abductor pollicis, arising from the os 
calcis, and immediately divides into two branches: 

(1) The Internal Plantar Artery is the smallest, and 



212 



PRACTICAL ANATOMY. 



ramifies among the mass of muscles situated on the 
inner edge of the sole of the foot. 

(2) The External Plantar Artery directs its course 
outward, and having reached the metatarsal bone of the 
little toe, forms the Plantar Arch, which crosses the 
three middle metatarsal bones obliquely, about their 



Fig. 69. 
Arteries on the Back of the Thigh, Leg, and Foot. 




1, 2. Popliteal Artery. 

3. Anastomotic Artery, the Last Branch 

of the Femoral. 

4. Superior Internal Articular Artery. 

5. Superior External Articular Artery. 

6. Inferior Internal Articular. 
Azygos xlrtery. 

Sural or Grastrocnemial Arteries. 
Point at which the Popliteal divides 

into the Anterior and Posterior Ti- 
bial Arteries. 

Point at which the Posterior Tibial 
gives off the Peroneal Artery; being 
called thus far the Tibio-Peroneal 
Artery. 

Nutritious Artery of. the Tibia. 

Continued Trunk of the Posterior Ti- 
bial Artery. 

12. Peroneal Artery. 

13. External Malleolar Artery. 

14. External Plantar Artery. 

15. Internal Malleolar Artery. 

16. Inferior External Articular Artery. 



7. 



2. 



9. 



10. 
11. 



middle, and terminates at the space betwixt the two first 
metatarsal bones, where the trunk of the anterior tibial 
artery joins the arch. The convexity of this arch is 
toward the toes, and sends off the following branches : 



POSTERIOR PART OF THE LEO. 213 

a. A small branch to the outside of the little toe. 

b. Ramus digitalis primus, or the first digital artery, 
which runs along the space between the two last meta- 
tarsal bones, and bifurcates into two branches, one to 
the inner side of the little toe, and the other to the outer 
side of the next toe. 

c. The second digital artery, which runs along the 
next interosseous space, and bifurcates in a similar 
manner. 

d. The third digital artery. 

e. The fourth, or Great Digital Artery, which 
supplies the great toe, and the inner side of the toe 
next to it. 

The concavity of the arch sends off the Interosseal 
arteries, three or four small twigs, which go to the deep- 
seated parts in the sole of the foot, and, Perforating 
between the metatarsal bones, inosculate with the supe- 
rior interosseal arteries on the upper side of the foot. 

The branches of the Posterior Tibial Artery in the 
leg are 

1. The Peroneal Artery, which comes off from the 
tibial a little after it has sent off the anterior tibial ; it 
is generally of a considerable size ; it runs upon the in- 
side of the fibula, giving numerous branches to the 
peroneal muscles and flexor of the great toe; its course 
is irregular. At the lower part of the leg it splits into 

a. A. Peronea Anterior, which passes betwixt the 
lower heads of the tibia and fibula, to the forepart of 
the ankle, where it is lost. 

b. A. Peronea Posterior is properly the termina- 
tion of the artery; it descends along the sinuosity of 
the os calcis, inosculating with the branches of the 
tibialis postica, and terminates in the posterior part of 
the sole of the foot. 

2. Muscular branches arise from the artery as it de- 
scends ; twigs also are sent over the heel and ankle. 

2. Veins. 
Venje Tibiales Posticle. — The posterior tibial veins 
are generally two in number ; they accompany the artery, 



214 PRACTICAL ANATOMY. 

and terminate in the popliteal vein ; they are formed of 
branches, which correspond to those of the artery. 

3. Nerves. 

The Posterior Tibial Nerve, which is the continu- 
ation of the great sciatic nerve, sinks below the soleus, 
and accompanies the posterior tibial artery ; it gives off 
numerous filaments to the muscles in its neighborhood. 
At first it is immediately behind the artery, gradually 
getting on the outside of it as it descends ; so that where 
they pass along the sinuosity of the os calcis, the nerve 
is situated close in contact with the side of the artery, 
but nearer to the projection of the heel than that vessel 
is. With the artery, it divides into 

1. The internal plantar nerve, and 

2. The external plantar nerve. — These nerves supply 
the muscles and integuments in the sole of the foot. 

Dissection of the Sole of the Foot. 

The cuticle is very much thickened on the sole of the 
foot from constant pressure; betwixt the integuments 
and plantar aponeurosis, we find a tough granulated fat, 
which adheres firmly to the aponeurosis, and is dissected 
off with difficulty. 

Aponeurosis, seu Fascia Plantaris, is a very strong 
tendinous expansion, which arises from the projecting 
extremity of the os calcis, and passes to the root of the 
toes, covering and supporting the muscles of the sole of 
the foot. Where it arises from the heel, it is thick, but 
narrow; as it runs over the foot it becomes broader and 
thinner ; and it is fixed to the head of each of the met- 
atarsal bones by a bifurcated extremity, which, by its 
splitting, leaves room for the tendons, etc. to pass. It 
seems divided into three portions, which are connected 
by strong fasciculi of tendinous fibres ; and fibres are 
sent down, forming perpendicular partitions among the 
muscles, and separating them into three classes : 

1. The middle portion, which is the largest, and under 
which are contained the flexor brevis digitorum, and the 
tendons of the flexor longus and lumbricales. 



SOLE OF THE FOOT. 



215 



2. The external lateral portion, which covers the 
muscles of the little toe. 

8. The internal lateral portion, concealing the muscles 
of the great toe. 

On removing the plantar aponeurosis, the first order 
of muscles in the sole of the foot is exposed ; it consists 
of three muscles: 

1. Abductor Pollicis Pedis — Arises, tendinous and 
fleshy, from the lower and inner part of the os calcis; 
from a ligament which extends from the os calcis to the 
os naviculare ; from the inside of the os naviculare and 
cuneiforme internum ; and from the fascia plantaris. 

Inserted, tendinous, into the internal sesamoid bone 
and base of the first phalanx of the great toe. 

Use. To move the great toe from the rest. 



Fig. 70. 
Muscles of the Side of the Foot. 



1. Abductor Pollicis. 

2, 2. Its Tendon. 

3, 3. Flexor Brevis Pollicis. 

4. Tendon of Flexor Longus Pollicis. 

5. Aponeurosis Plantaris, divided. 
6, 7. Flexor Brevis Digitorum Pedis. 

7. Lumbricales. 

8. Abductor Minimi Digiti. 

9. Flexor Brevis Minimi Digiti. 
10. Interossei. 




2. Abductor Minimi Digiti Pedis — Arises, tendin- 
ous and fleshy, from the outer side of the os calcis, and 



216 PRACTICAL ANATOMY. 

from a strong ligament which passes from the os calcis 
to the metatarsal bone of the little toe ; also from the 
fascia plantaris. 

Inserted, tendinous, into the base of the metatarsal 
bone of the little toe, and into the outside of the base 
of the first phalanx. 

This muscle can frequently be divided distinctly into 
two portions. 

Use. To move the little toes from the other toes. 

3. Flexor Brevis Digitorum Pedis Perforatus — 
Arises, fleshy, from the anterior and inferior part of the 
protuberance of the os calcis, and from the inner surface 
of the fascia plantaris ; also from the tendinous parti- 
tions betwixt it and the abductors of the great and little 
toe. It forms a thick fleshy belly, and sends off four 
tendons, which split for the passage of the tendons of 
the flexor longus digitorum, and are 

Inserted into the second phalanx of the four lesser toes. 

The tendon of the little toe is often wanting. 

Use. To bend the second joint of the toes. 

The first order of muscles being removed, or being 
lifted from their origins and left hanging by their ten- 
dons, the second order is exposed. 

1. The tendon of the flexor longus digitorum pedis is 
seen coming from the inside of the os calcis, and, having 
reached the middle of the foot, dividing into its four ten- 
dons, which pass through the slits of the tendons of 
the flexor digitorum brevis, and are inserted into the base 
of the last phalanx of the four lesser toes. 

2. The tendon of the Flexor longus pollicis is seen 
crossing under the tendon of the flexor longus digitorum, 
and, having given to it a short slip of tendon, proceed- 
ing between the two sesamoid bones to the base of the 
last phalanx of the great toe. 

3. Flexor Digitorum Accessorius, or Massa Carnea 
Jacobii Sylvii — Arises, fleshy, from the sinuosity at 
the inside of the os calcis, and tendinous from that bone 
more outwardly. It forms a belly of a square form. 

Inserted into the outside of the tendon of the flexor 
digitorum longus, just at its division. 



MUSCLES OF THE FOOT. 217 

Use. To assist the flexor longus. 

4. Lumbricales Pedis — Arises, by four tendinous 
and fleshy beginnings, from the tendons of the flexor 
longus digitorum, immediately after their division. 

Inserted, by four slender tendons, into the inside of 
the first phalanx of the four lesser toes, and into the 
tendinous expansion that is sent from the extensors to 
cover the upper part of the toes. 

Use. To promote the flexion of the toes, and to draw 
them inward. 

The second order of muscles being removed, we ex- 
pose the third order : 

1. Flexor Brevis Pollicis Pedis — It arises, ten- 
dinous, from the under and fore part of the os calcis, 
where it joins with the os cuboides ; also from the os 
cuneiforme externum. It forms a fleshy belly, which is 
connected inseparably to the abductor and adductor 
pollicis. 

Inserted, by two tendons, into the external and in- 
ternal sesamoid bones ; and it is continued on into the 
base of the first phalanx of the great toe. 

Use. To bend the first joint of the great toe. 

2. Adductor Pollicis Pedis — Arises, tendinous and 
fleshy, from a strong ligament which extends from the 
os calcis to the os cuboides, and from the roots of the 
second, third, and fourth metatarsal bones. It forms a 
fleshy belly, which seems at its beginning divided into 
two portions. 

Inserted, tendinous, into the external sesamoid bone 
and root of the metatarsal bone of the great toe. 
Use. To bring this toe nearer the rest. 

3. Flexor Brevis Minimi Digiti Pedis — Arises, 
tendinous and fleshy, from the os cuboides, and from the 
root of the metatarsal bone of the little toe. 

Inserted, tendinous, into the base of the first phalanx 
of the little toe and into the anterior extremity of the 
metatarsal bone. 

Use. To bend this toe. 

4. Transversalis Pedis — Arises, tendinous, from 
the anterior extremity of the metatarsal bone supporting 



218 



PRACTICAL ANATOMY. 



the little toe; becoming fleshy, it crosses over the ante- 
rior extremities of the other metatarsal bones. 

Fig. 71. 

Dissection of a Second Layer of the Plantar Muscle of the 

Foot. 



(( l" [ "" nn " , "!|. 



1. Tendon of Tibialis Posticus. 

2. Tendon of Flexor Longus Pollicis. 

3. Tendon of Flexor Longus Digitorum. 

4. Point where it separates into four Ten- 

dons. 

5. Points of Insertion. 

6. Flexor Accessorius. 

7. Calcaneo-cuboid Ligament. 

8. Lumbricales Pedis. 

9. Adductor Pollicis. 

10. Flexor Brevis Pollicis. 

11. Tendon of Peroneus Longus. 

12. Flexor Brevis Minimi Digiti. 

13. Interossei Muscles. 



Inserted, tendinous, into the anterior extremity of the 
metatarsal bone of the great toe, and into the internal 
sesamoid bone adhering to the adductor pollicis. 

Use. To contract the foot, by bringing the toes nearer 
each other. 

Ranging with this order of muscles, we may also 
observe — 

A broad strong ligament, passing from the anterior 
sinuosity of the os calcis over the surface of the os cu- 
boides. 

The tendon of the tibialis posticus, dividing into 
numerous tendinous slips, to be inserted into the bones 
of the tarsus. 

Having removed the muscles last described, we ex- 
pose the fourth and last order. 




MUSCLES OF THE FOOT. 



219 



The tendon of the peroneus longus is seen passing 
along a groove in the os cuboides, and crossing the 
tarsal bones, to be inserted into the base of the meta- 
tarsal bone of the great toe, and into the internal cunei- 
forme and second metatarsal bones. 

Fig. 72. 
Plantar Interossei. 



1. Metatarsal Bone of the Great Toe. 

2, 2, 2. Interosseous Muscles. 

3, 3, 3. Their Insertion into the First Pha- 

lanx. 



Interossei Pedis Interni are three in numbel, 
situated in the sole of the foot. They arise, tendinous 

Fig. 73. 
Dorsal Interossei Muscles. 




1. First Metatarsal 
Bone. 
2, 2. Interossei Muscles. 
3, 3, 3, 3. Their tendinous in- 
sertion into the first 
Phalanges of the 
Toes. 




220 PRACTICAL ANATOMY. 

and fleshy, from between the metatarsal bones of the 
four lesser toes, and are 

Inserted, tendinous, into the inside of the base of the 
first phalanx of each of the three lesser toes. 

Use. To move the three lesser toes inward toward the 
great toe. 

Interossei Pedis Externi are four in number, 
larger than the internal interossei, and situated on the 
back of the foot; they are bicipites, or arise by two 
slips. 

Arise, tendinous and fleshy, between the metatarsal 
bones of all the toes. 

Inserted, the first, abductor indicis pedis, into the in- 
side of the base of the first phalanx of the fore- toe; — 
the second, adductor indicis pedis, into the outside of 
the same toe; — the third, adductor medii digiti pedis, 
into the outside of the middle toe; the fourth, adductor 
tertii digiti pedis, into the outside of the third toe. 

Use. To separate the toes. 



CHAPTER XII. 



DISSECTION OF THE PERINEUM AND 0E THE MALE 
ORGANS OF GENERATION. 

The subject should be secured as in the operation for 
stone. A staff passed into the bladder, and some hair 
into the rectum. Carry two incisions, one upon either 
side, from the root of the scrotum to the tuberosities of 
the ischii ; from thence to the point of the coccyx, and 
dissect the flap upward. 

The muscles of the perineum consist of five pair, and 
a single muscle : 

Erector Penis, ^ 

Accelerator Urin^:, I u r a™™-™.*™ \^ 

T**™™™ p™™ I on each / Sphincter Ani, 



Transversus Perinei, 
Levator Ani, 
Coccygeus, 



side. \ single muscle. 



MALE ORGANS OF GENERATION. 221 

The Raphe, or line running along the skin of the 
perineum, marks the place where the opposite muscles 
meet. The appearance of these muscles will vary in 
different subjects. In those who have died weak and 
emaciated, the fibres will be pale, and not very evident, 
while in strong muscular men, who have expired sud- 
denly, they will be very distinct. When the fat and 
superficial fascia have been carefully cleared away, the 
first muscle coming into view will be the superficial 
sphincter ani ; and in front of the anus, a shining fascia 
will be seen stretching across from the ramus of the 
pubes and ischium of one side to the same points on the 
other. This is the Superficial Perineal Fascia of 
some, the Middle Perineal fascia of others. All in 
front of the anus is called the anterior or urethral peri- 
neum. This fascia covers the muscles of this part of 
the perineum, and, instead of continuing back over the 
superficial sphincter ani, dips down in front of the anus, 
and becomes connected with the anterior layer of thg 
triangular ligament, or Deep Perineal fascia. On 
either side of the rectum, and the tuberosities of the 
ischii, are two large deep fossae, filled with granulated 
fat, and having bloodvessels and nerves from the Inter- 
nal Pudic Artery, vein, and nerves. These are the 
Ischio-Rectal Fossae. The outer boundary of these 
cavities is formed by the obturator internus muscles, 
covered by the obturator fascia ; the inner boundary by 
the levator ani muscles, covered by the fascia of the 
same name. Clean off the fascia, and you will expose 
the following muscles : 

1. The Erector Penis — Arises, tendinous and fleshy, 
from the tuberosity of the os ischium ; its fleshy fibres 
proceed upward over the crus of the penis, adhering to 
the outer and inner edges of the ascending ramus of the 
os ischium, and of the descending ramus of the os 
pubis; — but before the two crura meet to form the body 
of the penis, it ends in a flat tendon, which is lost in the 
strong tendinous membrane that covers the corpus cav- 
ernosum. 

Situation. This muscle covers all the surface of the 
crus penis that is not in contact with bone. 



222 PRACTICAL ANATOMY. 

Use. It was formerly supposed to compress the cms 
penis, and thereby to propel the blood into the forepart 
of the corpus cavernosum ; and to press the penis up- 




View of the Deep Perineal Fascia. 

1. Symphysis Pubis. 

2. Sub-pubic Ligament. 

3. Triangular Ligament, or Deep Perineal Fascia. 

4. Perforation for the Urethra. 

5. Two prominences of anterior layer of the Fascia, marking 

the Position of the included Cowper's Glands. 

6. Pudic Arteries. 

7. Arteries of the Bulb. 

8, 8, 8. The Superficial Perineal Fascia dissected off in three angu- 
lar Flaps. 

ward against the pubis. But its obvious effect must be 
that of drawing the crus downward to the tuber ischii ; 
which cannot have any influence in contributing to the 
erect state of the organ. 

2. Accelerators Urines — Arise from a tendinous 
point in the centre of the perineum, and a tendinous 
line in the middle of the bulb. The fibres diverge. The 
inferior ones 

Inserted into the ramus of the ischium and pubis. 



MALE ORGANS OF GENERATION. 



223 



The middle surround the corpus spongiosum, and the 
anterior ones extend upon the corpus cavernosum. 

Use. To drive the urine and semen forward, by com- 
pressing the lower part of the urethra, and to propel 
the blood toward the corpus spongiosum and the glans 
penis. 

Fig. 75. 




Perineal Muscles of the Male. 



1. 


Accelerator Urinae. 


7. Gluteus Maximus. 


2. 


Erector Penis. 


8. Adductor Magnus. 


3. 


Transversus Perinsei. 


9. Gracilis. 


4. 


Sphincter Ani. 


10. Adductor Longus. 


5. 


Levator Ani. 


11, 13. Corpora Cavernosa, 


6. 


Coccygeus. 


12. Urethra. 




14, 14. 


Spermatic Cords. 



3. The Transversus Perinjei — Arises from the 
tuber ischii, immediately behind the attachment of the 
erector penis; thence its fibres run transversely inward. 

Inserted into the central point of union where the 
sphincter ani touches the accelerator urinse, and where a 
kind of tendinous projection is formed, common to the 
five muscles. 

Use. To dilate the bulb of the urethra, to prevent the 
anus from being too much protruded, and to retract it 
when protruded. 

The middle perineal fascia passes behind these muscles 



224 PRACTICAL ANATOMY. 

to join the deep or triangular ligament. Accompanying 
these muscles, is the Transversales Perinei arteries 
(from the superficial perineal arteries), which, coming 
from the internal pudic, pass up in the groove between 
the erectores penis and accelerators urinas. 

There is sometimes another slip of fibres, the Trans- 
versa Perinei Alter, which has the same course, and 
is inserted into the posterior part of the bulb of the 
urethra. 

4. The Sphincter Ani Externus consists of two 
semicircular planes, which run round the extremity of 
the rectum, passing nearly as far out as the tuber ischii; 
the fibres of each side decussate where they meet, and 
are 

Inserted into the extremity of the os coccygis behind ; 
and before, into a tendinous point common to this muscle 
and to the acceleratores urinas and transversi perinei. 
This tendinous point is worthy of remark; it seems to 
consist in part of an elastic ligamentous substance. 

Use. To close the anus, or extremity of the rectum, 
and to pull down the bulb of the urethra. It is in a 
state of constant contraction, independently of the will. 

5. Sphincter Ani Internus — a band of fibres under 
the superficial sphincter, surrounding the lower end of 
the rectum. 

More deeply seated than the muscles now described, 
we see some of the fibres of 

The Levator Ani. — This muscle arises from the in- 
side of the os pubis, at the upper edge of the foramen 
thyroideum, from the inside of the os ischium, from the 
tendinous membrane covering the obturator internus and 
coccygeus muscles; from the semicircular origin its 
fibres run down like radii toward a centre, and are 

Inserted in the two last bones of the os coccygis, and 
into the extremity of the rectum, passing within the 
fibres of the sphincter ani, but on the outside of the 
longitudinal fibres of the gut itself. 

Situation. This muscle, with its fellow, very much re- 
sembles a funnel, surrounding the extremity of the rec- 
tum, the neck of the bladder (which passes through a 



MALE ORGANS OF GENERATION. 225 

slit in its fibres), the prostate gland, and part of the 
vesicufe seminales. 

Use. To draw the rectum upward after the evacua- 
tion of the feces, to assist in shutting it, and to com- 
press the vesicufe seminales and other viscera of the 
pelvis. 

6. The Coccygeus arises, tendinous and fleshy, from 
the spinous process of the os ischium, and covers the in- 
side of the posterior sacro-sciatic ligament; it forms a 
thin fleshy belly. 

Inserted into the extremity of the os sacrum, and into 
the lateral surface of the coccygis, immediately before 
the gluteus maximus. 

Situation. It is placed betwixt the levator ani and 
edge of the gluteus maximus. 

Use. To support and move the os coccygis forward, 
and connect it more firmly with the sacrum. 

If the muscles be cleared away, the corpus spongiosum 
will be found to rest upon a dense membrane, which ; s 
placed beneath the arch of the pubes, and between the 
rami of the pubes and ischii. It is the Triangular 
Ligament. This ligament consists of two layers, be- 
tween which is placed the membranous portion of the 
urethra, the glands of Oowper, and some muscular fas- 
ciculi termed the muscles of Wilson and Guthrie. The 
internal pudic artery, with nerve, is likewise between its 
lamelfe, and gives off a large branch, the Arteria 
Bulbosi, and another, the Arteria Cavernosi. The 
main trunk finally becomes the Arteria Dorsalis 
Penis. 

The rectum must now be separated from the bladder, 
and pulled downward. This dissection will expose a 
great part of the levator ani ; the neck and body of the 
bladder ; the prostate gland ; the vesicuhe seminales ; 
part of the vasa deferentia ; part of the ureters ; the 
urethra, its bulb, and corpus spongiosum; the crura 
penis, and their origin from the ischium ; observe 

1. The connection of the bladder and rectum, and 
the cellular substance interposed between them. 

2. The prostate gland, situated between the bladder 

11 



226 PRACTICAL ANATOMY. 

and rectum, surrounding the beginning of the urethra 
in such a manner that one-third of its thickness is situated 
above the urethra, and two-thirds below it; its shape is 
somewhat pyriform. 

3. The Urethra. — The curve should be carefully- 
observed. The urethra begins at the neck of the blad- 
der; it is a continuation of that part of the bladder 
which in the erect posture is lowest. (1) Its begin 
ning is imbedded in the prostate gland. (2) Its mem- 
branous part is quite narrow; situated between the 
prostate gland and bulb of the urethra, and between the 
layers of the triangular ligament. (3) The urethra then 
enters the corpus spongiosum. 

4. The Corpus Spongiosum Urethra consists of a 
plexus of minute veins covered externally by a thin but 
uniform fibrous sheet; it surrounds the urethra from a 
short distance from the bladder to its extremity. At its 
beginning it forms a considerable body of a pyriform 
shape, termed the Bulb of the Urethra; that part of the 
bulb which is below the urethra is named the pendulous 
part of the bulb. The corpus spongiosum has on its 
anterior the glans penis. 

5. The Glandule Anteprostat^e, or Cowper's 
Glands, are two small glands of the size of peas be- 
tween the layers of the triangular ligament. 

6. The Vesicul^i Seminales are two soft, whitish, 
knotted bodies, about three or four fingers' breadth in 
length and one in breadth, and about three times as 
broad as thick: situated between the rectum and lower 
part of the bladder obliquely, so that their inferior ex- 
tremities are contiguous, and are affixed to the base of 
the prostate gland, while their superior extremities are 
at a distance from each other, extending outward and 
upward, and terminating just on the inside of the inser- 
tion of the ureters in the bladder. They consist of 
coiled tubes. N 

7. The two Vasa Deferentia are seen running be- 
twixt the vesiculae seminales, and united to them and to 
the base of the prostate. Their union forms the Ducti 
Ejaculatorii. Observe that part of the bladder left 



MALE ORGANS OF GENERATION. 



227 



between these tubes, and connected by cellular sub- 
stance to the rectum, which is pierced when the bladder 
is punctured from the latter part, no peritoneum inter- 



vening. 



Fie. 76. 



Base of the Bladder, with the Vesicul^e Seminales, Ureters, 
and Prostate Gland. 



1. Muscular Structure of the Blad- 
der. 

2, 2. Ureters. 

3, 3. Yasa Deferentia. 

4. Vesicula Seminalis. 

5. Same of the opposite side, dis- 

sected out to show its tubular 
character. 

6. Efferent Duct of the Vesicula 

Seminalis, which joins the Duct 
of the Vas Deferens to form at 7 
the Ductus Ejaculatorius. 

8. Prostate Gland. 

9. Urethra. 




8. The Corpora Cavernosa Penis arise, on each 
side, by a process named the Crus, from the ramus and 
from the tuber ischii, ascend along the ischium and 
pubis, and are united immediately before the cartila- 
ginous arch of the pubis. They consist of erectile tis- 
sue, covered by a strong, white, fibrous substance, which 
is very elastic. Internally they are cavernous, and are 
separated from each other by a septum, which, from 
being perforated, is named Septum pectiniforme. 

By the union of the two corpora cavernosa, two 
grooves are formed: (1) A smaller one above, in which 
two arteries pass, 1 a large vein or two betwixt them, 
and some large twigs of nerves. (2) A larger groove 
below, which receives the urethra. 

9. The prepuce is a fold of skin forming a sheath or 
covering for the glans penis. It makes a duplicature 



1 Arteria Dorsalis Penis. It is the termination of the internal pudic 
artery. 



228 PRACTICAL ANATOMY. 

extending along the flat part of the glans from its basis 
to the orifice of the urethra, termed Fbjenum Pr^putii. 

10. The Vesica Urinaria, or Urinary Bladder, is 
situated within the pelvis, immediately behind the ossa 
pubis and before the rectum. It is covered on its upper 
and back part by a reflection of peritoneum; in front 
and below (where it is contiguous to the rectum) it is 
connected by cellular membrane to the surrounding 
parts. Shape, oval, but flattened before and behind, 
and, while in the pelvis, somewhat triangular. Divided 
into the Fundus or bottom, Corpus or body, and Cervix 
or neck. At the top of the bladder, above the symphy- 
sis pubis, may be observed the superior ligament of the 
bladder, consisting of the Uraehus, a ligamentous cord, 
which runs up between the peritoneum and linea alba as 
far as the navel and two of the ligamentous cords, which 
are the remains of the umbilical arteries, and run up 
from the sides of the bladder. The bladder is also con- 
nected in front by two ligaments formed by the pelvic 
fascia, and passing to the viscus from either side of the 
symphysis, and on its sides also by the pelvic fascia. 

Observe the parts of the bladder not covered by peri- 
toneum, as they are the situations of surgical operations. 
These are the whole anterior surface, lying against the 
pubis, and rising above it, when the bladder is distended, 
so that it may be punctured above the pubis ; the sides, 
at the very lowest part of which the cut is made in the 
lateral operation of lithotomy, and where the viscus may 
be punctured from the perineum: and the inferior sur- 
face, resting on the rectum, and allowing us to puncture 
from it. Observe also the direction of the axis of the 
bladder, in conformity with which all instruments should 
be introduced; this is in a line drawn from the navel to 
the os coccygis. 

11. The entrance of the ureters into the bladder on 
the outside of the vesiculse seminales. 

12. The rectum, following the curve of the os sacrum 
and os coccygis. 

To have a more connected view of the relative situa- 
tion of these important parts, one side of the pelvis 



MALE ORGANS OF GENERATION. 229 
Fig. 77. 




A Side View of the Viscera oe the Male Pelvis, in situ. The 
Right Side of the Pelvis has been removed by a Vertical 
Section made through the Pubis near the Symphysis, anp 
another through the middle of the Sacrum. 

1. The Divided Surface of the Pubis. 

2. The Divided Surface of the Sacrum. 

3. The Body of the Bladder. 

4. Its Superior Fundus; from the Apex is seen passing upward 

the Urachus. 

5. The Inferior Fundus of the Bladder. 

6. The Ureter. 

7. The Neck of the Bladder. 

8, 8. The Pelvic Fascia ; the Fibres immediately above 7 are given 
off from the Pelvic Fascia, and represent the Anterior Liga- 
ments of the Bladder. 
9. The Prostate Gland. 

10. The Membranous Portion of the Urethra, between the two 

Layers of the Deep Perineal Fascia, or the Triangular Liga- 
ment. 

11. The Triangular Ligament, or Deep Perineal Fascia formed of 

two Layers. 

12. One of Cowper's Glands between the two Layers of the Tri- 

angular Ligament, and beneath the Membranous Portion of 
the Urethra. 

13. The Bulb of the Corpus Spongiosum 

14. The Body of the Corpus Spongiosum. 

15. The Right Crus Penis. 

16. The Upper Part of the Rectum. 

17. The Recto-vesical Fold of Peritoneum. 

18. The Middle Portion of the Rectum. 



230 PRACTICAL ANATOMY. 

19. The Right Vesicula Seminalis. 

20. The Vas Deferens. 

21. The Rectum covered by the Descending Layer of the Pelvic 

Fascia, just as it is making its bend backward to terminate 
in the Anus. 

should now be removed by dividing the symphysis pubis, 
and by sawing through the os ilium, or separating it at 
its junction with the sacrum. By carefully removing all 
the cellular membrane, the student will be enabled more 
accurately to examine the situation of the parts above 
described. 

Of the Vessels and Nerves contained within the Pelvis. 

1. Arteries. 

The A. Iltaca Interna, having left the trunk of the 
iliaca communis, passes immediately into the pelvis, 
where it gives off several large arteries. 

1. A. Ileo-Lumralis supplies the psoas and iliacus 
internus muscles. 

2. A. Sacr.^e Laterales, two or three small vessels 
which supply the sacrum, cauda equina, and neighbor- 
ing parts. 

3. A. Glutea (or iliaca posterior), a very large 
branch, passes out of the pelvis through the upper part 
of the sciatic notch to supply the haunch; but, in its 
passage, it gives some branches to the os sacrum, os coc- 
cygis, the rectum, and the muscles situated within the 
pelvis. 

4. A. Sciatica passes out of the pelvis by the sciatic 
notch and below the pyriformis muscle to supply the 
hip ; in its passage it gives branches to the neighboring 
parts. 

5. A. Pudica (pudenda communis or interna) is the 
branch of the internal iliac or ischiatic which is more 
immediately destined to supply the parts of generation, 
perineum, and lower part of the rectum. It goes out 
of the pelvis above the superior sacro-sciatic ligament, 
twists round it, and re-enters the pelvis above and before 
the inferior sacro-sciatic ligament ; it then descends on 



ARTERIES OE THE PELVIS. 



231 



the inside of the tuber ischii, ascends on the inner sur- 
face of the rami of the ischium and pubis, and, reaching 
the root of the penis, divides into two branches. Super- 
ficial and deep. 

Fig. 78. 




Arteries of the Pelvis. 



1. Termination of the Aorta. 

2. Middle Sacral Artery. 
3 A Lumbar Artery. 

4. Primitive Iliac Artery. 

5. External Iliac Artery. 

6. Circumflex Iliac Artery. 

7. Epigastric Artery. 

8. Remains of the Umbilical Ar- 

tery of the Fcetus converted 
into a Ligament. 



9. Obturator Artery. 

10. Vesical Artery. 

11. Ilio-lumbar Artery. 
12 and 13. Lateral Sacral 



Arte- 



14. Gluteal Artery. 

15. Middle Hemorrhoidal Artery. 

16. Internal Pudic Artery. 

17. Ischiatic Artery. 



(1) A. Superficial Perineal, a branch, which gives 
twigs to the bulb of the urethra 'and neighboring mus- 
cles and skin. Noticed in the dissection of the peri- 
neum. 

(2) Arteria Bulbosi, to the bulbous part of the 
urethra. 

(3) A. Cavernosi, to the cavernous bodies. 

(4) A. Dorsalis Penis passes under the arch of the 
pubis, runs along the dorsum penis, and is distributed to 
the integuments. 



232 PRACTICAL ANATOMY. 

While in the pelvis, the pudic gives twigs to the blad- 
der, prostate, and rectum. 

2. Veins. 

The veins attend the arteries and their ramifications ; 
they unite to form the internal iliac vein, except the 
veins from the rectum, named hdemorrJioidales, which 
ascend along its back part to join the inferior mesenteric 
vein. 

3. Nerves. 

The nerves met with in this dissection consist of nu- 
merous twigs sent off from the lumbar and sacral nerves 
to supply the parts about the pelvis. 

But, in this dissection, we meet with three pair of 
large nerves, which have their course through the pelvis, 
and pass to the thigh. 

1. Course of the Anterior Crural Nerve while in 
the pelvis. The anterior crural nerve is formed by 
branches of the first, second, third, and fourth lumbar 
nerves ; at its origin, it lies under the psoas magnus, and, 
as it descends, passes betwixt the psoas magnus and 
iliacus internus, till, having passed under Poupart's lig- 
ament, it emerges from betwixt those muscles, and ap- 
pears on the outer side of the femoral artery. 

2. Course of the Obturator Nerve within the pel- 
vis. This nerve is formed by branches of the second, 
third, and fourth lumbar nerves ; it lies under the in- 
ternal border of the psoas magnus, descends into the 
pelvis, and goes obliquely downward, to accompany the 
obturator artery through the thyroid hole. 

3. Course of the Great Sciatic Nerve within the 
pelvis. This nerve arises by branches from the fourth 
and fifth lumbar, and three first sacral nerves, which 
unite together to form the largest nervous trunk in the 
body. The nerve passes betwixt the pyriformis and 
gemini, and thus escapes from the back part of the pelvis 
by the sciatic notch. Sometimes one of the branches 
goes through the pyriformis, and joins the sciatic trunk 
at the back part of the pelvis. 



THE SCROTUM. ^33 



Of the Scrotum. 



The scrotum consists externally of a loose, rugose 
skin, and internally of the Dartos, consisting of un- 
striped muscular tissue. 

On dividing the anterior part of the scrotum, on 
either side of the raphe, we expose a grayish coat, which 
is the Tunica Vaginalis Testes. Tunica vaginalis is 
derived from the peritoneum, carried down in the de- 
scent of the testicle ; it consists, therefore, like all serous 
membranes, of two layers, with a cavity within. The 
outer layer is the tunica vaginalis reflexa; the internal 
one, the tunica vaginalis propria. Removing this, an- 
other very dense coat, the Tunica Albuginea, within 
which may be seen the proper glandular structure of 
the testes, having on its upper edge an appendage termed 
Epididymis, a little enlarged above and below the Globus 
Major and Minor, all of which are convoluted tubes. 

2. The Spermatic Cord, connecting the testicle to the 
abdominal ring. It consists of 

a. The spermatic artery, a branch of the aorta ; this 
divides into several branches, which enter the upper edge 
of the testicle. 

b. The spermatic veins, which form a plexus that 
terminates in the abdomen in a single vein. 

c. The spermatic nerves, which come from the sympa- 
thetic and lumbar nerves. 

d. The vas deferens, or excretory duct of the testicle. 
This is situated in the back part of the cord, and is dis- 
tinguished by its firm cartilaginous feel. 

e. These parts are all connected by cellular mem- 
brane, and by the tunica vaginalis, which is covered by 
a thin muscle. 

/. The cremaster. This arises from the obliquus de- 
scendens internus, and is lost on the tunica vaginalis. 

It is well now to take out the bladder and penis, and, 
laying them open by an incision which shall pass through 
the upper wall of the urethra and bladder, notice the in- 
ternal appearance. The bladder consists of four coats, 
the peritoneal one, as has been stated, incomplete ; the 

11* 



234 



PRACTICAL ANATOMY. 



others are muscular, cellular, and mucous. The muscu- 
lar coat consists of fibres running in different directions. 
The mucous coat is generally found thrown into folds in 
the undistended state of the organ. Some distance be- 




A View of a Portion of the Inside of the Bladder, with the 
Prostate Gland appended to it by the Attachment of the 
Common Tendon of the Muscles of the Ureters. 

1, 1. Inside of the Bladder. 
2. Lower Fundus. 

3, 3. Mouths of the Ureters. 

4, 4. Muscles of the Ureters, from which the Mucous Membrane has 

been dissected. 

5. Junction of the Muscles at the apex of the Vesical Triangle. 

6. Tendon of the United Muscles. 

7. Middle Lobe of the Prostate and Point of Insertion, according 

to Sir Charles Bell. 

8. Caput Gallinaginis, the Point of Insertion according to Doctor 

Horner. 



THE URETHRA. 



23^ 



hind its neck is a smooth triangular surface, the Vesical 
Triangle. The entrance to the ureters corresponds to 
the posterior angles, and the mouth of the urethra to 
the apex or anterior angle. The sides of this triangle 
are sometimes ridged up ; and, if the mucous membrane 
be removed, a few muscular fibres are sometimes seen, 
which have been described as the muscles of the ureters. 
A pointed projection in the orifice of the urethra is the 
uvula vesicas. 

Urethra. — The first part of the urethra passes 
through the prostate gland, which, having in its structure 
much unstriped muscular tissue, can compress it. This 
portion is called the prostatic portion. In this part we 
have a prolonged elevation of its mucous membrane, the 

Fig. 80. 

The Prostatic, Membranous, and Part of The Spongy Portion 
of the Urethra with Part of the Bladder. 



1. 

2. 
3. 
4. 
5. 
6. 

7, 7. 

8, 8. 



9, 9. 
a. 

b, b. 

c, c. 
d. 



f,f. 

g* g- 
h. 



Internal Surface of the Bladder. 

Vesical Trigone. 

Openiugs of the Ureters. 

Uvulse Vesicae. 

Urethral or Gallinaginous Crest- 
Opening of the Sinus Pocularis. 

Openings of the Ejaculatory Ducts. 

Openings of the Prostatic Ducts. 
The numbers 7, 7, and 8, 8, are 
placed on the cut surface of the 
Supra-urethral portion of the 
Prostate Gland. 

Lateral Lobes of the Prostate Gland. 

Membranous Portion of the Urethra. 

Cowper's Glands. 

Mouths of the Ducts of the same. 

Commencement of the Spongy Por- 
tion of the Urethra. 

Upper Surface of the Bulb. 

Roots of the Cavernous Bodies. 

Corpora Cavernosa. 

Spongy Portion of the Urethra. 




Caput Gallinaginis ; on its sides are the openings of 
the Ducti Ejaculatorii. On each side of the caput 
is a considerable depression, the Prostatic Sinuses. 
The numerous openings upon their floors are those of 



236 PRACTICAL ANATOMY. 

the Prostatic Ducts. Sinus Pocularis: an opening 
in front of the Caput Gallinaginis. 

Membranous Portion — in advance of the prostatic, 
and is eight to twelve lines in length. 

Bulbous Portion — so much of the urethra as trav- 
erses the bulb. 

Spongy Portion — the remaining part of the canal. 
Just behind its termination is a fossa, the Fossa Navi- 
culars. Mucous lacunae are scattered over the surface 
of the canal. 

The Glands of Cowper — two little bodies placed 
between the layers of the triangular ligament, and 
opening by two ducts into the anterior part of the 
bulbous urethra. 



CHAPTER XIII. 

dissection of the organs of generation in the 

FEMALE. 

Previous to the dissection, it will be proper to ex- 
amine the external parts. 

The Mons Veneris is a rounded prominence, covered 
with hairs after puberty. It consists of the common 
integuments, with an additional quantity of cellular and 
adipose substance, and lies upon the forepart of the ossa 
pubis. From the inferior part of the mons veneris 
arise 

The Labia Externa, called also the labia majora ; 
they are continued downward and forward in the direc- 
tion of the symphysis pubis and terminate in the peri- 
neum anterius: they consist of integuments, cellular 
substance, and fat, are thicker above than below, and 
are red and vascular on their inner side. The places 
where the labia are joined to each other above and below, 
are termed Commissures; the lower commissure the 
Fourchette. 



FEMALE ORGANS OF GENERATION. 



237 



The longitudinal cavity, or fissure, situated betwixt 
the labia, and extending from the mons veneris to the 
perineum anterius, is sometimes called the Sinus Pu- 
doris; it is broader above than below, and contains 
several other parts. 

On separating the labia, we see, immediately below 
the superior commissure, 

Fig. 81. 
The Vulva. 



1. Mons Veneris. 

2. Right Labium. 

3. Right Nympha. 

4. Clitoris, of which only the An- 

terior extremity is seen. 

5. Vestibule. 

6. Orifice of the Urethra. 

7. Commencement of the Vagina. 

8. Fourchette. 

9. Navicularis Fossa. 

10. The Anus. 

11. Perineum. 



The Clitoris, a red projecting body, situated below 
the arch of the pubis, and partly covered by its Pre- 
puce, -The prepuce is a fold of skin, continued from 
the inner surface of the labia, so as to cover the supe- 
rior and lateral part of the clitoris. The clitoris re- 
sembles the penis of the male, and consists of two cav- 
ernous bodies ; these, however, cannot be traced in this 
stage of the dissection. That part of the body which 
forms an obtuse projection externally, is called the 
Glans. 

The Perineum Anterius is that portion of the soft 
parts which extend from the inferior commissure of the 
labia to the anus. 

The Perineum Posterius is the space betwixt the 
anus and point of the os coccygis. 

Labia Interna, or Nympele, are two prominent 
doublings of the integuments, extending from the glans 




238 PRACTICAL ANATOMY. 

of the clitoris to the sides of the vagina. Their exter- 
nal side is continued from the inner surface of the labia, 
and from the prepuce of the clitoris. 

Vestibulum — A space bounded above by the clito- 
ridis, and laterally by the nymphse. At its lower part 
we see the orifice of the urethra, above the orifice of the 
vagina ; it consists of a small rising prominence like a 
pea, in the centre of which is a small opening or hole. 

The Hymen, or Circulus Membranosus, is a thin and 
extensile membrane, formed by a doubling of the lining 
membrane of the vagina, much contracted in virgins. 
It generally has an opening in its upper part. 

After the destruction of the hymen, in married women, 
we see some irregular projections marking the orifice of 
the vagina, and termed Caruncul^e Myrtiformes. 

Behind these is the Vagina, or canal leading to the 
uterus ; at the extremity of which may be felt project- 
ing the Os Uteri, or Os Tinc^;, but it cannot be seen 
without dissection. 

The skin should be now divided on the side of the 
right labium, and the dissection should be carried from 
the groin to the side of the anus ; the cellular membrane 
must be carefully removed, in order to expose the fol- 
lowing parts. 

We find the Clitoris consisting of two spongy bodies 
termed Crura, which unite and form the body. The crus 
of each side is a cavernous body, arising from the ramus 
and upper part of the tuberosity of the ischium, con- 
tinued along the ramus of the os pubis, and uniting with 
its fellow opposite to the symphysis pubis. The body 
formed by the crura does not extend upward, but forms 
a curve downward toward the urethra ; it is divided in- 
ternally by the Septum Pectiniforme, and is attached 
to the symphysis pubis by a suspensory ligament; it is 
invested by a ligamentous membrane. 

The muscles which are met with in this dissection 
consist of four pair, and two single muscles. 

The Erector Clitoridis, 

Transversus Perinei, 

T A ? > on each side. 

Levator Ani, 

Coccygeus, 



FEMALE ORGANS OF GENERATION. 



239 



two single muscles. 



The Sphincter Ani, 
Sphincter Vaginae, 

1. The Erector Clitoridis arises, fleshy and tendin- 
ous, from the tuber ischii, from the inside of the ramus 
of the os ischium, and from the ramus of the os pubis ; 
it passes over the crus of the clitoris, and, becoming 
tendinous, is lost upon it. 

Use. To draw the clitoris downward and forward, 
and, by compressing it, to propel the blood. 

Fig. 82. 




Muscles of the Female Perineum. 



1, 2, 6. Sphincter Vaginas Muscle. 
3, 4. Erector Clitoridis 
5, 11. Transversus Perinsei ' 

7. Levator Ani 

8. Gluteus Maximus 

9. Sphincter Ani 



10. Junction of the Sphincter 
Ani and Sphincter Vaginae 
Muscles. 

12. Adductor Magnus. 

13. Gracilis. 



Arising from the same point and surrounded by much 
cellular membrane, we find 

2. The Transversus Perinei. — Its origin is the 
same as in the male. 

It is inserted into a ligamentous substance in the per- 
ineum anterius, at the point where the sphincter ani 
and sphincter vaginae meet. 

This ligamentous or tendinous substance deserves at- 



240 PRACTICAL ANATOMY. 

tention. Here, as in the male, it is the point of union 
into which muscles are inserted. 
Use. To sustain the perineum. 

3. Surrounding the extremity of the vagina, and a 
small part of the vestibulum, we find the Sphincter 
Vagina ; it arises, anteriorly, from the crura of the cli- 
toris and pubis on each side ; it surrounds the orifice of 
the vagina, and is 

Inserted into the ligamentous point of the perineum. 
Use. To contract the mouth of the vagina, and com- 
press the plexus retiformis. 

4. The Sphincter Ani exactly resembles the same 
muscle in the male. 

5. The Levator Ani resembles the same muscle of 
the male ; it surrounds the sides of the vagina in part, 
and consequently assists in constricting and support- 
ing it. 

6. The Coccygeus is longer than in the male. 

* Under the fibres of the sphincter vaginae you will find 
the Plexus Retiformis, or Corpus Spongiosum Va- 
gina, a spongy body, consisting of cellular substance, 
interwoven with a number of convoluted bloodvessels. 
It arises from the sides of the clitoris, passes on each 
side of the extremity of the vagina. 

The Vagina is the canal leading from the vestibulum 
to the uterus. It lies betwixt the rectum and inferior 
surface of the urethra and bladder, and is connected to 
them by cellular membrane. It is composed of fibro- 
elastic substance, very vascular ; its inner surface is ru- 
gose, and occupied by mucous glands. On slitting it up, 
we see, at its posterior extremity, the Os Uteri, a rounded 
projection, with a transverse fissure. 

The Uterus, or Womb. — This organ is best seen from 
the cavity of the abdomen. It is situated betwixt the 
bladder and rectum, to both of which it is connected by 
reflections of peritoneum ; it is of the shape of a pear, 
and of a firm consistence. The broad upper part of the 
womb is called the Fundus Uteri, the narrower part is 
named the neck, or Cervix Uteri, and the intermediate 
part its Body. 



FEMALE ORGANS OF GENERATION. 



241 



If the uterus be slit open, its cavity will exhibit the 
following appearances : Its entrance, the Os Externum, 
moderately large. Then a constricted portion, Cervix, 
which expands into a triangular cavity, at the upper 
angles of which open the Fallopian Tubes. 

Fig. 83. 
Transverse Section of the Uterus and Part of the Vagina. 



1. Cavity of the Body. 

2. Cavity of the Neck, its walls 

marked by fine oblique 
ridges. 

3. Cervico-vaginal Orifice (Os 

Uteri). 

4. Cervico-uterine Orifice. The 

two bristles are introduced 
through the Orifices of the 
Fallopian Tubes. 




The uterus has four ligaments, two on each side : 

The LiaAMBNTUM Teres, or Round Ligament. It 
is a round long cord, extending from the side of the 
fundus uteri, and passing through the abdominal ring, 
to be lost in the groin. 

The Ligamentum Latum, or Broad Ligament, is a 
broad fold of peritoneum, reflected from the body of the 
uterus, and connecting it on the sides of the pelvis. The 
duplicature of the broad ligament incloses the Fallopian 
tube, ovary, and round ligament. 

The Fallopian Tubes are two. Each tube is con- 
tained in the upper part of the doubling of the broad 



242 PRACTICAL ANATOMY. 

ligament ; it goes out from the fundus of the womb, and 
is a slender hollow tube. Its outer end is curved down- 
ward and backward, and terminates by a broad fringed 
extremity, termed Morsits Diaboli, or the Fimbriae. 
This broad extremity is connected to the next pair of 
organs. 

Fig. 84. 




Anterior View of the Uterus and its Appendages. 

1. Body of the Uterus. 

2. Its Superior Border or Fundus. 

3. Its Neck (Cervix). 

4. Its Mouth (Os Uteri). 

5. The Vagina. 

6, 6. Broad Ligament formed by the Peritoneum, which has been 
removed from the Opposite Side. 
7. Prominence formed by the Subjacent Ovary. 

8, 8. The Round Ligaments, cut where they enter the Internal In- 

guinal Ring. 

9, 9.. Fallopian Tubes 

10, 10. Their Fimbriated Extremities — on the Left side the Extremity 
of the Tube is turned forward, to show its Mouth or Ab- 
dominal Orifice. 

11. The Ovary. 

12. The Utero-Ovarian or Broad Ligament. 

13. One of the Processes of the Fimbriated Extremity of the 

Tube connected to the Ovary. 

14. Cut Edge of the Peritoneum on the Anterior Surface of the 

Uterus — this Membrane is represented here as descending 
rather lower upon the organ than is really the case. 

The Ovaria are two small oval bodies, white and flat, 
situated by the side of the uterus, and inclosed in the 
posterior fold of the broad ligament behind the Fallopian 
tube; each ovarium is connected to the fundus uteri by 
a short round ligament, Ligamentum Ovarii. 



FEMALE ORGANS OF GENERATION. 



243 



The Bladder is situated before the uterus, and is 
described in the preceding chapter. 

The Urethra is short in females (one inch to one and 
a half long), and near the bladder is surrounded by a 
spongy substance. 

Fig. 85. 




51 02 

Left Half of a Vertical Section of the Female Pelvis, with 
the Rectum, Vagina, and Bladder laid open, and the Uterus 
turned to the left slde. 



1. Bladder. 7. Left Fallopian Tube. 

2. Urachus. 8. Left Ovary. 

3. Anterior Ligament of the Blad- 9. Uterus. 

der. 10. Vagina. 

4. Urethra. 11, 12. Anterior and Posterior Ver- 

5. Rectum. tical Bands or Pillars of the 

6. Transverse Folds or Pouches Vagina. 

of the Rectum. 13. Clitoris. 



The Ureter descends from the kidneys over the 
psoas muscle; it runs for some space betwixt the bladder 
and vagina, and at last perforates the bladder near the 
neck. 



244 PRACTICAL ANATOMY. 

The Rectum lies behind the uterus. (See the pre- 
ceding chapter.) 

To obtain a more satisfactory knowledge of the rela- 
tive situation of the parts, the left side of the pelvis 
should be removed as in the male, and the parts ex- 
amined in that situation. 



CHAPTER XIV. 

OF PARTS WITHIN THE THORAX. 

The cavity may be exposed by dividing the cartilage 
from the ribs, and taking these out with the sternum. 

On looking under the sternum, while it is lifted up, 
we see the Mediastinum, separating, as it is gradually 
torn from the posterior surface of the sternum, into two 
layers, and thus forming a triangular cavity. This 
cc.vity is artificially produced, and is entirely owing to 
the method of raising the sternum. 

When the sternum is laid back or removed, the fol- 
lowing parts are to be observed : 

The Mediastinum, now collapsed, dividing the thorax 
into two distinct cavities, of which the right is the largest. 

The lungs of each side lying distinct in these cavities. 

The pericardium, containing the heart, situated in the 
middle of the thorax, between the two laminae of the 
mediastinum, and protruding into the left side. 

The internal surface of the pleura, smooth, colorless, 
and glistening, lining the ribs, and reflected over the 
lungs. 

1. The Pleura. — Each side of the thorax has its 
particular pleura. The pleurae are like two bladders, 
situated laterally with respect to each other, by adhering 
together in the middle of the thorax, and passing ob- 



PARTS WITHIN THE THORAX. 245 

liquely 1 from the posterior surface of the sternum to the 
dorsal vertebrae, they form the mediastinum. The 
pleura lines the ribs and the upper surface of the dia- 
phragm, and is reflected over the lung, which is in fact 
behind it. It forms the Ligamentum Latum Pul- 
monis, a reflection of membrane, which connects the 
inferior edge of the lungs to the spine and diaphragm. 

2. The Lungs. — Color, reddish in children, grayish 
in adults, and bluish in old age. Shape, corresponding 
to that of the thorax, somewhat pyramidal, convex to- 
ward the ribs, concave toward the diaphragm, and irreg- 
ularly flattened next the mediastinum. 

Division. (1) The Right Lung is the largest, and is 
divided into three lobes, two greater ones, and an inter- 
mediate lesser lobe. 

(2) The Left Lung has two lobes, and also a square 
notch opposite the apex of the heart. Into the sulci or 
grooves which form the divisions of the lungs into lobes, 
the pleura enters; that part of the lung which is affixed 
to the spine is called its root ; it is the part by which 
the great vessels, nerves, and bronchiae enter. 

3. The Pericardium is a strong, white, and compact 
membrane, smooth, and lubricated upon the inside, 
forming a bag for containing the heart, and having its 
inner lamina reflected over the substance of the heart 
itself. 

4. When you slit open the forepart of the pericardium, 
you expose the Heart. The right ventricle protrudes; 
the right auricle, also, is toward you; while the left 
auricle is retired, and its tip is seen lapping round upon 
the left ventricle. From under the tip of the left auricle 
a branch of the coronary vein, and one of the coronary 
arteries ramify toward the apex of the heart, marking 
the situation of the Septum Cordis. The left ventricle 
will be found firm, fleshy, and resisting, while the right 

1 They run obliquely, not being in general attached to the middle 
of the sternum, but toward its left side, especially at the lower part 
of the bone, near the diaphragm. Besides the pericardium, the 
mediastinum contains betwixt its laminee some adipose membrane 
and absorbent glands. 



246 



PRACTICAL ANATOMY. 



ventricle is more loose, and seems partly wrapt round 
the other. 

Fie. 




A Front View of the Larynx, Trachea, and Lungs, with the 
Heart inclosed in the Pericardium. 



1. Thyroid Cartilage. 

2. Oico-tkyroid Muscle. 

3. Trachea. 

4, 5, 6. Upper, Middle, and 

Lower Lobes of the 

Right Lung. 
7, 8. Upper and Lower Lobes 

of the Left Lung. 
9, 9. Pericardium investing 

the Heart. 

10. Mediastinum. 

11. Left Subclavian Artery. 



12. Left Primitive Carotid. 

13. Right Primitive Carotid. 

14. Left Subclavian Artery. 

15. Left Vena Innominata. 

16. Right Vena Innominata. 

17. Right Subclavian Vein. 

18. Right Internal Jugular. 

19. Left InternalJugular. 

20. Left Subclavian Vein. 

21. Root of the Lungs. 

22. Ligamentum Pulmonis. 



The heart is situated obliquely in the middle of the 
breast ; its posterior surface is flat, and lies upon the 



PARTS WITHIN THE THORAX. 247 

diaphragm ; its apex is turned forward and toward the 
left side, so that, in the living body, it is felt striking 
between the fifth and sixth ribs, at the point where the 
cartilages and bony extremities are united. The Vena 
Cava Superior is seen coming down from the upper 
angle of the pericardium. The Inferior Cava is seen 
coming up through the diaphragm; but only a very 
small part of this vein is covered by the pericardium ; 
the two veins enter the right auricle. The Right 
Auricle is turned forward, and might be called the 
anterior; it generally appears black, by the blood shin- 
ins; through its thin coats. The Right Ventricle is 
situated almost directly opposite. The Pulmonary 
Artery arises from the right ventricle ; its root is con- 
cealed by the right auricle ; it ascends on the left side 
of the aorta; it divides into — 1, the right pulmonary 
artery, which passes under the arch of the aorta, crosses 
behind it and the vena cava superior to the right lung, 
and is the longest; and 2, the left pulmonary artery, 
which passes to the left lung, crossing the descending 
aorta anteriorly. The Pulmonary Veins enter the 
left auricle; two veins come from each lung; the right 
veins are longest, as they pass behind the vena cava 
superior. The left auricle is situated on the left side of 
the right auricle, and somewhat behind it; its tip is seen 
lapping round upon the Left Ventricle. This is situ- 
ated behind, and on the left side of the right ventricle; 
its substance is stronger and more firm to the touch. 
The Aorta arises from the back part and right side of 
the left ventricle; its root is covered by the pulmonary 
artery. It then ascends betwixt that artery and the 
vena cava superior. Immediately from the root of the 
aorta, within the pericardium, the two coronary arteries 
are sent off to supply the heart itself. 

Dissection of the Great Vessels of the Heart. 

The Vena Cava Superior will be seen descending 
before the root of the lungs, and on the right side of the 
aorta. Immediately before perforating the pericardium, 



248 



PRACTICAL ANATOMY. 

Fig. 87 




a. Right Ventricle of the 
Heart. 
a, a, and b, 6. Pericardium. 



b. Pulmonary Artery, 
c, c. Arch of Aorta. 
d. Right Auricle. 



PARTS WITHIN THE THORAX. 249 

e. Fibrous Remains of the p. Right Subclavian Artery 

Ductus Arteriosus through crossed by the Pneumogas- 

which the Pulmonary Ar- trie Nerve. 

tery of the Foetus commu- q. Right Common Carotid Ar- 

nicated with the Aorta. tery. 

/. Superior Cava. r. Trachea. 

g. Left Brachiocephalic Vein. s. Thyroid Gland. 

h. Left Common Carotid Ar- t. Brachial Plexus of Nerves. 

tery. u. Upper End of Left Internal 

k. Lower End of the Left In- Jugular Vein. 

ternal Jugular Vein. v, v. Clavicles cut across and dis- 

l. Right Jugular Vein. placed downward. 

m. Right Subclavian Vein. z, x. Fifth Ribs cut across. 

n. Innominata or Brachio ce- y, y. Right and Left Breasts. 

phalic Artery. z. Lower End of Sternum. 

0. Left Subclavian Artery. 

it is joined upon its posterior part by the vena azygos, 
which comes forward from the spine, returning the blood 
from the intercostal spaces. 

Behind the sternum, and just above the arch of the 
aorta, the superior cava is seen receiving two great 
branches. 

1. A branch coming from the right side, formed by 
the right subclavian vein, and the right internal jugular. 

2. A larger branch coming from the left side (Vena 
Transversa or Innominata). It is formed by the 
left subclavian and left internal jugular, which unite to 
form a trunk. This trunk crosses before the arteries 
arising from the arch of the aorta, and then enters the 
superior vena cava. Into the posterior part of the angle 
formed by the union of the left subclavian and the left 
jugular, the thoracic duct empties itself. 

On each side the internal jugular vein descends along 
the neck by the side of the carotid, while the subclavian 
vein comes from the arm. 

The Vena Cava Inferior, immediately after passing 
through the diaphragm from the abdomen, enters the 
pericardium. 

The Aorta leaves the heart opposite the fourth dorsal 
vertebra ; it crosses over the pulmonary artery, ascends 
obliquely upward, backward, and to the right side, as 
high as the second dorsal vertebra. Here it forms an 
Arch or incurvation, which passes from the right to the 

12 



250 PRACTICAL ANATOMY. 

left side, and at the same time obliquely from before 
backward. It then comes in contact with the upper 
part of the third dorsal vertebra, and descends along 
the spine in the posterior mediastinum. This arch of 
the aorta is situated behind the first bone of the sternum, 
behind and somewhat below the left branch of the vena 
cava superior. 

From the upper part of the arch come off three large 
arteries. 

1. The Arteria Innominata, or common trunk of 
the right carotid and subclavian, ascends above an inch, 
and bifurcates into 

a. The Right Carotid, which ascends in the neck by 
the side of the trachea. 

b. The Eight Subclavian, which passes outward to 
the arm. 

2. The Left Carotid. 

3. The Left Subclavian comes off from the ex- 
tremity of the arch. 

The arch of the aorta also gives off some small twigs 
which pass to the pleura, the mediastinum, and thymus 
gland. 

The Thymus Gland is a soft glandular body, lying 
before the lower part of the trachea and great vessels of 
the heart, a little higher than the tops of the two pleurae. 
It is very large in the foetus, smaller in adults, and nearly 
disappears in the aged. 

Where the aorta begins to descend, it is connected to 
the pulmonary artery by a ligament, which, in the foetus, 
was a large canal, the Ductus Arteriosus. 

Dissection of the Posterior Mediastinum, 1 and of the 
Nerves and Vessels which have their course through 
the Thorax. 

Course of the Phrenic K"erve through the thorax. — 
On each side this nerve is seen entering the thorax be- 
twixt the subclavian artery and subclavian vein. It then 

1 By Posterior Mediastinum is designed that part of the mediastinum 
situated behind the root of the lungs. 



PARTS WITHIN THE THORAX. 251 

proceeds downward and forward before the root of the 
lungs, and on the outside of the pericardium, betwixt 
that bag and the pleura. It is lost on the diaphragm. 
This nerve is accompanied by one artery and two veins. 
Some twigs pass from the phrenic nerve into the abdomen, 
to the liver, etc. 

Behind the arch of the aorta and great vessels passing 
from the heart, is seen the Trachea. It enters the 
thorax between the two pleura, and, opposite the third 
or fourth dorsal vertebra, bifurcates into two parts, 
bronchia, one of which passes toward the right, the 
other toward the left, to enter the lung of each side. 

These bronchiae divide and subdivide, finally ending in 
the Air Cells. The trachea and larger bronchiae con- 
sist of cartilaginous rings, defective on the posterior 
third, which is filled up by muscular tissue. 

Fig. 88. 




Terminal Vesicles of the Lung, hanging to a Branch of the 
Bronchia as Berries hang to their Stalk. 

By folding back the lungs toward the left side of the 
chest, we expose the pleura reflected from the under sur- 
face of the root of the lungs to the spine and ribs. A 
triangular space is formed betwixt the trwo pleurae and 
the bodies of the dorsal vertebrae. This space or cavity 
is named the cavity of the posterior mediastinum. It 
contains many important parts, and must, therefore, be 
carefully dissected. 

But first let us attend to the course of the Great 
Sympathetic Nerve. 

Cardiac Plexus. — From the three sympathetic gan- 
glia of the neck come off three nerves, called the Supe- 



252 PRACTICAL ANATOMY. 

rior Middle, and Inferior Cardiac Nerves. The 
superior cardiac receives filaments from the superior 
laryngeal branch of the par vagum. These nerves, with 
branches also from the recurrent laryngeal of the par 
vagum, send filaments about the great bloodvessels at 
the root of the neck, and afterward form, between the 
arch of the aorta and the lower part of the trachea, the 
Cardiac Plexus. 

The Sympathetic Nerve, where it enters the thorax, 
is situated behind the great vessels, close upon the 
articulation of the first rib with the body of the first 
dorsal vertebra as it descends along the thorax. It lies 
upon the heads of the ribs, where they are articulated 
with the vertebrse. It receives additional branches from 
all the dorsal intercostal nerves, and in each intercostal 
space it forms a ganglion. This nerve may be dissected 
with greater facility when the lungs are removed, and 
the ribs sawed off near the spine, which will enable the 
dissector to trace its branches more fully. It lies behind 
the pleura, but is seen through it. It passes into the 
abdomen by the side of the spine, running through the 
fibres of the small muscle of the diaphragm. 

Branches of the Sympathetic in the Thorax. 

The Great Splanchnic Nerve should be attended 
to. It is formed by twigs, which come off from the sixth, 
seventh, eighth, ninth, and tenth thoracic ganglia, and 
penetrates, with the aorta, the diaphragm. Lesser 
Splanchnic Nerve, formed by filaments from the tenth 
and eleventh dorsal ganglia, it passes through the crus 
of the diaphragm, and partly uniting with the great 
splanchnic, they together terminate in the Semilunar 
Ganglion, which is formed by a number of smaller ones 
connected by many filaments, constituting the Solar 
Plexus, and placed at the root of the Cceliac Axis. 

The Solar Plexus also receives twigs from the par 
vagum and the phrenic nerves. The Phrenic, Hepatic, 
Splenic, Mesenteric, Spermatic, and Renal Plex- 
uses all emanate from the Solar, and are formed by 
filaments winding about the bloodvessels of these parts. 



PARTS WITHIN THE THORAX. 



253 



Lumbar Ganglia — four in number, and connecting 
with the lumbar spinal nerves. 



Fig. 89 




A. Front View of the Larynx, 
Trachea, and Bronchial 
Tubes. 

1. Hyoid Bone. 

2. Thyro-hyoid Membrane. 

3. Thyroid Cartilage. 2, 

4. Crico- thyroid Membrane. 

5. Cricoid Cartilage. 

6. Trachea. 

7, 8. Two Cartilaginous rings. 
9. Membrane which separates 
them. 

10. Right Bronchus and its di- 6, 7 

visions. 8 

11. Left Bronchus. 



5. 



The Larynx, Trachea, and 
commencement of the Bron- 
chial Tubes, viewed from 

BEHIND. 

Upper opening of the Larynx, 
Lateral grooves of the Larynx. 
Fibrous Membrane of the 

Trachea, interspersed with 

small Glands, beneath which 

is seen 
The Muscular Fibres ; beneath 

this last are seen 
Small Fibrous Bands. 
The Mucous Membrane seen 

between them. 



254 



PRACTICAL ANATOMY. 



Fig. 90. 
Vena Azygos and Thoracic Duct. 




1. External Iliac Vein. 

2. Internal Iliac Vein. 

3. Ascending Cava. 

4. Middle Sacral Vein. 
5, 5. Lateral Sacral Veins. 

6. Origin of the Greater Vena 

Azygos in the Lumbar 
Region and from the 
Lumbar Veins. 

7. Its Trunk. 

8. Its Termination in the 

Descending Cava. 

9. Lumbar Veins of the Left 

Side, forming at 

10. The Lesser Vena Azygos, 

which terminates at 

11. In the Greater Azygos. 

12, 12, 12. Eight or nine Inferior In- 

tercostal Veins of the 
Right Side, opening into 
the Greater Azygos. 

13, 13, 13. Superior Intercostal 

Veins, opening by a 
common Trunk into the 
Greater Vena Azygos. 

14, 14, 14. Five Inferior Intercostal 

Veins of the Left Side, 
joining the Lesser Azy- 
gos. 
15. Receptaculum Chyli. 
16, 16, 16. Thoracic Duct. 

17. Its Termination in the 

Angle formed between 
the Left. Internal Jugu- 
lar and Left Subclavian 
Veins. 

18. Right Thoracic Duct. 

19. Subclavian Vein 

20. Internal Jugular Vein. 



Hypogastric Plexus is formed by branches from 
the lumbar and aortic plexuses, and is distributed to 



PARTS WITHIN THE THORAX. 255 

the pelvic viscera. It is situated at the bifurcation of 
the aorta into the iliac arteries, and communicates with 
branches from the fourth and fifth sacral nerves. 

The sacral ganglia are five in number. The nerves of 
the two sides communicate over the coccyx, forming a 
ganglion, the Ganglion Impar. The cranial ganglia, 
six in number, are not described, as the student rarely 
pursues such a dissection in the limited time which he 
has for his dissecting-room duties. 

Toward the middle of the spine you see the Vena 
Azygos. In dissecting, it is found situated betwixt the 
right sympathetic nerve and the aorta; it begins below 
from ramifications of the lumbar veins, which pierce the 
small muscle of the diaphragm. This vein ascends along 
the spine, receiving veins from each of the intercostal 
spaces of the right side ; and, about the middle of the 
back, it receives a considerable trunk, which comes from 
under the aorta, Vena Azygos Minor, and returns the 
blood from the left side of the thorax. At the fourth 
dorsal vertebra, the vena azygos leaves the spine ; it 
makes a curve forward, and empties its blood into the 
back part of the vena cava superior, immediately before 
that vein enters the pericardium. The superior inter- 
costal veins on the left side empty into the vena azygos 
also. 

Descending through the posterior mediastinum will 
be also found the Aorta. This great artery, having 
formed its arch, comes in contact with the third dorsal 
vertebra, and is now called the Descending Aorta, or 
Thoracic Aorta. It descends along the bodies of the 
dorsal vertebrae, rather on their left side; it lies behind 
the oesophagus, and passes betwixt the crura of the 
diaphragm into the abdomen. 

Branches of the Aorta in the Thorax. 

1. The A. Intercostalis Superior, on the right 
side, is mostly sent off by the subclavian, on the left 
side by the aorta. 

The Inferior Intercostals are eight or nine in number 



256 PRACTICAL ANATOMY. 

on each side of the thorax: they come off separately 
from the side or back part of the aorta, and seem to tie 
that great artery to the spine. Each intercostal artery 
passes immediately into the interval betwixt two ribs, 
and there subdivides into 

(1) A branch which perforates between the heads of 
the ribs to the muscles of the back; this branch also 
gives twigs which enter the spinal canal. 

(2) The continued trunk of the artery runs forward, 
in the interval of the two ribs, giving many branches to 
the intercostal muscles. When it reaches the anterior 
part of the thorax it is lost in the muscles. 

Each intercostal artery is accompanied by one or two 
veins, branches of the vena azygos, and by an inter- 
costal or dorsal nerve. 

2. A. Bronchiales are two, sometimes three, small 
twigs of the aorta, one of which passes to the lungs on 
each side. 

3. Small arteries pass forward from the aorta on the 
oesophagus, named A. (Esophagese; others run to the 
pericardium and pleura. 

The dissector also finds in the posterior mediastinum 
the Thoracic Duct. He must look for it behind'the 
oesophagus, betwixt the vena azygos and aorta. It is 
collapsed, and appears like cellular membrane con- 
densed, and can only be distinguished when inflated or 
injected; it was seen in the abdomen close to the aorta, 
and passing into the thorax between the crura of the 
diaphragm. It ascends along the posterior mediastinum, 
and, about the fourth dorsal vertebra, passes obliquely 
to the left side, behind the aorta descendens, and behind 
the great arch of the aorta, until it reaches the left 
carotid artery. It runs behind this artery and behind 
the left internal jugular vein; and, after forming a cir- 
cular turn or arch, it descends and enters the left sub- 
clavian vein at the point where that vein is joined by 
the left internal jugular. The absorbents of the right 
superior extremity, and of the right side of the head and 
thorax, usually form a trunk, which enters the right 
subclavian vein. 



PARTS WITHIN THE THORAX. 257 

The (Esophagus is also situated betwixt the layers 
of the posterior mediastinum. It lies immediately be- 
fore the aorta, but rather toward its left side; it is seen 
descending from the neck behind the trachea; it passes 
through an opening in the lesser muscle of the dia*- 
phragm, and immediately expands into the stomach. 

Behind the trachea and vessels going to the lungs, 
and on the forepart of the oesophagus, we meet with a 
congeries of lymphatic glands. Its muscular fibres are 
arranged longitudinally and circular. 

Course of the Par Vagum, or Eighth. Pair of Nerves, in 
the Thorax. 

From the neck, the par vagum passes betwixt the 
subclavian vein and artery into the thorax ; it immedi- 
ately sends off a large branch, the Recurrent Nerve, 
back into the neck. On the right side, this branch twists 
round under the arteria innominata ; on the left side, 
under the arch of the aorta, it ascends behind the car- 
otid, and lodges itself betwixt the trachea and oesopha- 
gus, to both of which it gives branches, and to the mus- 
cles of the larynx. 

The par vagum, having given off the recurrent, de- 
scends by the side of the trachea and behind the root 
of the lungs. It here sends off numerous filaments to 
the lungs, which, uniting with twigs from the great 
sympathetic, form the Anterior and Posterior Pul- 
monary Plexuses. These plexuses lie on the anterior 
and posterior surfaces of the root of the lungs. Other 
twigs of the par vagum pass to form the inferior Car- 
diac Plexus about the pericardium. 

The trunk of the eighth pair soon reaches the oesoph- 
agus; the left par vagum runs on the forepart of the 
oesophagus, the right nerve on its back part. Here they 
split into several branches, which unite again and form 
a Plexus. This plexus is called the (Esophageal. 
The two nerves continue their course along the oesopha- 
gus, and pass with it through the diaphragm, to ramify 
on the stomach and form the stomachic plexus. 

12* 



258 PRACTICAL ANATOMY. 

The twelve dorsal or intercostal nerves are also seen 
in this dissection emerging from the spinal canal, be- 
tween the bodies of the vertebrae, and supplying the 
intercostal muscles, etc. 

Dissection of the Heart when removed from the Body. 

The heart consists of three tunics or coats. 1. An 
external smooth one, Exocardium, which is a reflection 
of the internal lamina of the pericardium. 2. A middle 
muscular coat. 3. A smooth internal coat, Endocar- 
dium, which is a continuation of the internal coat of 
the great veins and arteries. In the right side of the 
heart we always meet with a considerable quantity of 
coagulated blood. In the left side there is much less. 

Slit open, with the scissors, the two venae cavge on 
their forepart, the inner surface of these veins and of 
the right auricle will be seen lined by a smooth mem- 
brane ; and in the auricle the musculi pectinati, or 
bundles of muscular fibres, will be seen projecting in 
the auricular appendage. At the point of union between 
the two cavse, there is a projection formed by the thick- 
ening of the muscular coat, the Tuberculum Loweri. 
The Septum Auricularum is seen separating the right 
from the left auricle. Observe that it is thin, that in it 
there is an oval depression, named Fossa Ovalis. 
Round this fossa the fibres are thicker, forming the an- 
nulus ovalis; this is the remains of the Foramen Ovale 
of the foetus. The Eustachian Valve is a membrane- 
like duplicature of the inner coat of the auricle, ob- 
served where the vena cava inferior is continued into 
the auricle, and stretching from that vein toward the 
opening into the right ventricle. Behind this valve is 
the orifice of the Coronary Vein, with its small valve. 

The Foramina Thebesii are minute orifices, some of 
which are veins, which open into all the cavities of the 
heart; they are most numerous, however, in the right 
auricle. 

The Ostium Venosum, or opening of the right auricle 



PARTS WITHIN THE THORAX. 



259 



into the right ventricle, is somewhat oval; it has a valve 
which projects into the right ventricle. 

The Eight Ventricle may now be opened by an in- 
cision, carried from the root of the pulmonary artery 
down to the apex of the heart. This incision should be 
made with care, lest the parts on the inside of the ven- 
tricle be destroyed by it. It should pass along the right 
side of the septum ventriculorum, the situation of which 
is marked out by large branches of the coronary artery 
and vein. A small opening should first be made, into 
which one blade of the scissors can be introduced. The 
incision may be continued through the apex of the heart, 

Fig. 91. 

A View of the Interior of the Right Auricle and Right 
Ventricle. 



The Right Ventri- 
cle. 

Tricuspid Valve. 

Chords Tendineee. 

Pulmonary Artery. 

The Aorta. 

Descending Vena 
Cava. 

The Right Auricle. 

Orifice of the as- 8 
cending Vena 10 
Cava. 

Vena Cava As- 
cendens. 

Valvula Eustachii. 

Orifice of the De- 
scending Vena 
Cava. 

Position of the Tu- 
berculum Low- 
er i. 

Valvula Thebesii 
overhanging the 
orifice of the 
Coronary Vein. 



10. 
11. 



12. 



13. 




or a flap may be made by another cut, passing from the 
beginning of the first along the margin of the right 
auricle. In this ventricle, observe the projecting 



260 PRACTICAL ANATOMY. 

bundles of muscular fibres, the Tricuspid Valves 
arising from the margin of the ostium venosum, and 
projecting into the right ventricle. This valve forms a 
complete circle at its base, but has its edge divided into 
three parts, which are attached by tendinous filaments, 
named Chordje Tendine^e, to the Carney Columns, 
or muscular bundles of the ventricle. 

The Septum Ventriculorum, or partition of the two 
ventricles, is marked out externally by two veins run- 
ning from the apex to the basis of the heart. 

Slit up the pulmonary artery. Observe how it arises 
from the back part of the right ventricle, how smooth 
the inside of the ventricle becomes as it approaches the 
entrance of the artery, or ostium arteriosum. Observe 
the three Semilunar or Sigmoid Valves. Between the 
valves and wall of the artery are little sinuses, the Si- 
nuses of Valsalva. The bases of the valves arise from 
the artery, their loose edges project into its cavity, and 
in the middle of the loose edge of each valve is seen a 
small white body, termed Corpus Sesamoideum Arantii. 
The artery is seen bifurcating into the right and left pul- 
monary arteries, and, just before its bifurcation, sending 
off to the aorta the ductus arteriosus, which in the adult 
is a ligament. 

The Left Auricle has four pulmonary veins opening 
into its cavity, which may be exposed by slitting up two 
of those veins. Observe that its coats are thicker than 
those of the right auricle. The septum auricularum, 
with the fossa ovalis, is here seen less distinctly than on 
the right side. Observe also the ostium venosum, open- 
ing into the left ventricle, and giving attachment to the 
Valvula Mitralis. 

The Left Ventricle may be opened in the same 
manner as the right by an incision carefully made in the 
left side of the septum or partition of the ventricles, and 
continued round the upper part of the ventricle under the 
auricle. Observe the great thickness of the muscular 
coat; the Valvula Mitralis, forming two projections, 
which are attached by the chordae tendineae to the fleshy 
columns of this ventricle. 



POSTERIOR PART OF TRUNK AND NECK. 



261 



Fig. 92. 
A View of the Left Ventricle laid open. 



1. Parietes of the Ventricle. 

2. Its Cavity. 

3. Mitral Valve. 

4. Chordae Tendineoe. 

5. Columnae Carnese. 

6. Right Auricle. 

7. Left Auricle. 

9 8. The Four Pulmonary 
Veins. 
9. Aorta. 
10. Pulmonary Artery. 



Slit up the aorta. It has three semilunar valves, which 
resemble those of the pulmonary artery. Behind these 
valves the artery bulges out, as in the pulmonary, form- 
ing the Sinuses of the aorta. Above two of the valves 
lie the orifices of the two coronary arteries, of which the 
left is the largest. 




CHAPTER XV. 

dissection of the muscles on the posterior part 
of the trunk and neck. 



An incision must be made from the occipital protu- 
berance of the occipital along the spine to the top of the 
sacrum, and the integuments turned off. 

In this dissection we meet with twenty-two distinct 
pairs of muscles, besides a number of small muscles situ- 
ated between the processes of contiguous vertebrae. 



262 PRACTICAL ANATOMY. 

1. The Trapezius — It arises, by a thick round ten- 
don, from the lower part of the protuberance in the mid- 
dle of the os occipitis behind, and, by a thin tendinous 
expansion, from the superior transverse ridge of that 
bone; from the five superior cervico-spinous processes 
by the ligamentum nuchas; tendinous, from the two infe- 
rior cervical spinous processes, and from the spinous 
processes of all the vertebrae of the back. The fleshy 
fibres coming from the neck descend obliquely, while 
those from the back ascend. 

Inserted, fleshy, into the posterior third part of the 
clavicle; tendinous and fleshy, into the acromion, and 
into the upper edge of all the spine of the scapula. The 
fibres slide over a triangular surface at the extremity of 
the spine of that bone. 

Situation. This muscle is quite superficial, and con- 
ceals all the muscles situated in the posterior part of the 
neck and upper part of the back. The Ligamentum 
Nucile vel Colli is a ligament which arises from the 
middle of the occipital bone, runs down on the back part 
of the neck, adhering to the spinous processes of the cer- 
vical vertebrae, and giving origin to the fibres of the 
trapezius and of other muscles. 

Use. To move the scapula in different directions. The 
superior fibres draw it obliquely upward, the middle 
transverse ones draw it directly backward, and the infe- 
rior fibres move it obliquely downward and backward. 

It should be reflected from the spine and head. 

2. The Latissimus Dorsi — Arises, by a broad, thin 
tendon, from all the spinous processes of the os sacrum 
and of the lumbar vertebrae ; from the spinous processes 
of the seven inferior dorsal vertebrge from the posterior 
part of the spine of the os ilium ; also from the extremi- 
ties of the four inferior ribs, by four distinct fleshy digi- 
tations, which intermix with those of the obliquus ex- 
ternus abdominis. The inferior fleshy fibres ascend 
obliquely; the superior run transversely. They pass 
over the inferior angle of the scapula (from which the 
muscle often receives a thin fasciculus of fibres) to reach 
the axilla, where they are all collected and twisted. 



MUSCLES OF THE BACK. 
Fig. 93. 



263 




The First and Second and Part of the Third Layer of Mus- 
cles of the Back, the First Layer being shown upon the 
Right and the Second on the Left Side. 



1. Trapezius Muscle. 

2. Tendinous portion of the same, 

which, with the correspond- 
ing portion of the opposite 
Muscle, forms a Tendinous 
Ellipse on the lower part of 
the Back of the Neck. 

3. Acromion Process and Spine 

of the Scapula. 

4. Latissimus Muscle. 

5. Deltoid. 

6. Infra-spinatus and Teres Mi- 

nor Muscles. 



7. External Oblique of the 

Abdomen. 

8. Gluteus Medius Muscle. 

9. Gluteus Magnus. 

10. Levator of the Scapula. 
11, 12. Rhomboid Muscles (Small 

and Large). 
13, 14. Splenius Muscle. 

15. Aponeurosis covering the 
Spinal Erector Muscles. 
10. Serratus Inferior Posti- 
cus Muscle. 
17. Supraspinous Muscle. 



264 PRACTICAL ANATOMY. 

Inserted, by a strong flat tendon, into the inner edge 
of the groove in the os humeri, which receives the long 
tendon of the biceps flexor cubiti. 

Situation. Where this muscle arises from the dorsal 
vertebrae it is concealed by the origin of the trapezius. 
The remainder of it is placed immediately under the 
skin, and covers the deeper seated muscles of the loins 
and back. The tendon of this muscle, with the subjacent 
tendon of the serratus posticus inferior, assists in form- 
ing the fascia lumborum. 

Use. To pull the arm backward and downward, and 
to roll the os humeri. 

It should be reflected from the spine, pelvis, and ribs. 

Remove the trapezius and latissimus dorsi, and two 
muscles will be seen passing from the neck to the sca- 
pula. 

3. The Rhomboideus. — This muscle is divided into 
two portions. 

(1) Rhomboideus Major (the inferior portion) arises, 
tendinous, from the spinous processes of the four or five 
superior dorsal vertebrae. 

Inserted into all the base of the scapula below its 
spine, extending as far as its inferior angle. 

(2) Rhomboideus Minor (the superior portion) arises, 
tendinous, from the spinous processes of the three infe- 
rior vertebrae of the neck, and from the ligamentum 
nuchas. 

Inserted into the base of the scapula, opposite to the 
triangular plain surface at the root of the spine. 

Situation. This muscle lies beneath the trapezius and 
latissimus dorsi. 

Use. To draw the scapula obliquely upward and di- 
rectly backward. 

The rhomboidei should be reflected from the spine. 

4. The Levator Scapula — Arises from the trans- 
verse processes of the five superior vertebrae of the neck 
by five distinct tendinous and fleshy slips, which unite 
and form a considerable muscle. 

Inserted, tendinous and fleshy, into the base of the 



MUSCLES OF THE BACK. 



265 



scapula, above the root of the spine and under the supe- 
rior angle. 

Situation. This muscle is concealed by the trapezius 
and sterno-mastoideus; but a small part of its belly may 
be seen in the space between the edges of these muscles. 

Use. To draw the scapula upward and a little for- 
ward. 

Detaching the rhomboideus from its origin in the 
spine, you will see another muscle passing from the whole 
of the basis of the scapula. 

5. The Serratus Magnus — Arises, by nine fleshy 
digitations, from the nine superior ribs. These digita- 
tions are seen on the anterior part of the thorax ; they 
pass obliquely backward, and form a strong fleshy 
muscle. 

Fig. 94. 




The Serratus Major Anticus Muscle. 

Inserted, principally fleshy, into the whole of the 
base of the scapula. 

Situation. This muscle lies between the scapula and 
the ribs. The lower digitations, which pass more ante- 



266 PRACTICAL ANATOMY. 

riorly than the edge of the latissimus dorsi, are inter- 
mixed with the superior digitations of the obliquus ex- 
ternus abdominis. 

Use. To move the scapula forward, and, when the 
scapula is forcibly raised, to draw the ribs upward. 

The removal of the rhomboideus also exposes 

6. The Serratus Superior Posticus. — This muscle 
arises, by a thin, broad tendon, from the spinous pro- 
cesses of the three inferior cervical vertebrae, and of the 
two superior dorsal. 

Inserted, by distinct fleshy slips, into the second, 
third, fourth, and sometimes the fifth ribs, a little be- 
yond their angle. 

Situation. This muscle is concealed for the most part 
by the rhomboideus and scapula. 

Use. To elevate the ribs and dilate the thorax. 

Reflect it from the spine. 

7. The Splenius is divided into two portions. 

(1) The Splenius Capitis — Arises, tendinous, from the 
spinous processes of the two superior dorsal and five in- 
ferior cervical vertebrae. It forms a flat, broad muscle r 
which ascends obliquely, and is inserted, tendinous, into 
the posterior part of the mastoid process, and into a 
small part of the os occipitis, immediately below its 
superior transverse ridge. 

Situation. This muscle is covered by the trapezius, 
and by the insertion of the sterno-cleido-mastoideus, and 
a small part of it is seen on the side of the neck betwixt 
those two muscles. 

Reflect it from the occiput. 

(2) The Splenius Colli — Arises, tendinous, from the 
spinous processes of the third, fourth, fifth, and some- 
times the sixth dorsal vertebrae. It forms a small fleshy 
belly, which ascends by the side of the vertebrae, and is 
inserted into the transverse processes of the four or five 
superior cervical vertebrae, by distinct tendons, which 
lie behind similar tendons of the levator scapulae. 

Situation. This muscle is concealed by the serratus 
superior posticus and splenius capitis. 

Use. To bring the head of the upper vertebrae of the 



MUSCLES OF THE BACK. 



267 



neck obliquely backward. When both muscles act, they 
pull the head directly backward. 

Reflect it from the dorsal vertebrae. 

8. The Serratus Posticus Inferior — Arises, by a 
broad, thin tendon, from the spinous processes of the two 
or three inferior dorsal vertebrae, and from the three su- 
perior lumbar spines by the fascia lumborum. 

Inserted, by distinct fleshy slips, into the lower edges 
of the four inferior ribs, at a little distance from their 
cartilages. 

Fig. 95, 



1. Splenis Capitis. 

2. Complexus Major. 

3. Serratus Posticus Superior. 




Situation* This is a thin muscle, of considerable 
breadth, situated at the lower part of the back, under 
the middle of the latissimus dorsi. Its tendon lies under 
that of the latissimus dorsi, but, although firmly adher- 



268 PRACTICAL ANATOMY. 

ing to it, is distinct, and may be separated by cautious 
dissection. 

Use, To pull the ribs downward and backward. 

Reflect it from the spine. 

The Fascia Lumborum is now seen. It is a tendinous 
fascia, arising from the lumbar vertebrae and os sacrum, 
giving origin to the lower part of the serratus posticus 
inferior, and to the posterior fibres of the obliquus in- 
ternus and transversalis abdominis. It is also connected 
with the tendon of the latissimus dorsi. 

On detaching from the spine of this fascia, and the 
serratus posticus inferior, we expose a thick muscular 
mass, filling up all the space betwixt the spinous pro- 
cesses of the vertebrae, and the angles of the ribs. This 
mass consists of three muscles : 

(1) Sacro-Lumbalis on the outside. 

(2) Longissimus Dorsi in the middle. 

(3) Spinalis Dorsi close to the spinous processes. 
These three muscles are closely connected together; 

so that to effect their separation it is necessary to divide 
some of the fibres. 

9 and 10. The Sacro-Lumbalis and Longissimus 
Dorsi — Arise, by one common origin, tendinous exter- 
nally, and fleshy internally, from the spinous processes 
and posterior surface of the os sacrum; from the pos- 
terior part of the spine of the os ilium, extending nearly 
as far forward as the highest part of that bone when 
the body is erect; from the spinous processes, and from 
the roots of the transverse processes of all the lumbar 
vertebrae. 

The thick fleshy belly, formed by this extensive 
origin, ascends, and, opposite to the last rib, divides 
into the two muscles. 

The sacro-lumbalis is inserted into all the ribs near 
their angles, by long and thin tendons. The tendons 
which pass to the superior ribs are longer, ascend nearly 
straight, and are situated nearer to the spine than those 
tendons which pass to the lower ribs. On separating 
the inner edge of this muscle (i.e. the edge next to the 
spine) from the latissimus dorsi, and turning the belly 



MUSCLES OF THE BACK. 



209 



toward the ribs, we see six or eight small tendinous and 
fleshy bundles, which pass from the inner side of this 
muscle, to be inserted into the upper edge of the six or 
eight inferior ribs. These are called the Musculi Ac- 
cessorii ad Sacro-Lumbalem. 

Fig. 96. 
Third Layer of the Muscles of the Back. 



1, 2, 6, 8. Sacro-lumbalis Mus- 
cle turned outward 
to separate it from 
the Longissimus 
Dorsi, which lies 
between it and the { 
spine. 

3. Point at which these % 

two muscles are 
blended in one, the t 
Sacro- Spinalis, 

4. Complexus Minor. 

5. Complexus Major. 
7. Transversalis Cer- 




Use. To pull the rib downward, to assist in erecting 
the trunk of the body, and in turning it to one side. 



270 PRACTICAL ANATOMY. 

The longissimus dorsi is inserted into all the ribs ex- 
cept the two inferior, betwixt their tubercles and angles, 
by slips which are tendinous and fleshy, and into the 
transverse processes of all the dorsal vertebrae by small 
double tendons. 

Use. To extend the vertebrae, and keep the body 
erect. 

11. The Spinalis Dorsi is much smaller than the 
two last described muscles ; below, it cannot be separated 
from the longissimus dorsi, without dividing some fibres; 
it lies betwixt that muscle and the spine. 

Arises, tendinous, from the spinous processes of the 
two superior lumbar vertebrae, and of the three inferior 
dorsal. 

Inserted into the spinous processes of the nine upper 
vertebrae of the back, except the first, by as many dis- 
tinct tendons. 

Use. To extend the vertebrae, and to assist in raising 
the spine. 

12. The Cervicalis Descendens — Arises from the 
upper edge of the four or five superior ribs by as many 
distinct tendons, which lie on the inside of the tendinous 
insertions of the sacro-lumbalis. It forms a small belly, 
which ascends upward, and is 

Inserted, by three distinct tendons, into the fourth, 
fifth, and sixth cervical vertebrae. 

Situation. This muscle is small; it is frequently de- 
scribed as an appendage to the sacro-lumbalis. It arises 
between the sacro-lumbalis and longissimus dorsi, and is 
inserted into the transverse processes betw r een the splenius 
colli and levator scapulae. 

Use. To turn the neck obliquely backward. 

13. The Transversalis Colli — Arises from the 
transverse processes of the five superior dorsal vertebrae 
by five tendinous and fleshy slips, and is 

Inserted, tendinous, into the transverse processes of 
the five or six inferior cervical vertebrae. 

Situation. The origin of this muscle lies on the inside 
of the longissimus dorsi, and is sometimes considered as 



MUSCLES OF THE BACK. 



271 



an appendage to it. The insertion is situated between 
the cervicalis descendens and trachelo-mastoideus. 

Use. To turn the neck obliquely backward, and a 
little to one side. 

14. The Trachelo-Mastoideus lies nearer to the 
bone than the last described muscle. 

Arises from the transverse processes of the three 
uppermost vertebrae of the back, and of the five inferior 
of the neck, by as many thin tendons, which unite and 
form a fleshy belly. 

Fig. 97. 



1. Cervicalis Descendens. 

2. Semi-spinalis Colli 

3. Semi-spinalis Dorsi. 

4. Transversalis Colli. 




Inserted, tendinous, into the posterior surface of the 
mastoid process. 

Situation. This muscle lies on the outside of the com- 
plexus, and on the inside of the transversalis colli; its 
insertion is concealed by the splenius capitis. 

Use. To keep the head and neck erect, and to draw 
the head backward, and to one side. 

15. The Complexus — Arises, by tendinous and fleshy 
fibres, from the transverse processes of the seven superior 



272 PRACTICAL ANATOMY. 

dorsal, and of the four or five inferior cervical vertebrae. 
It forms a thick, tendinous, and fleshy belly. 

Inserted, tendinous and fleshy, into the hollow be- 
twixt the two transverse ridges of the os occipitis, extend- 
ing from the middle protuberance of that bone, nearly 
as far as the mastoid process. 

Situation, This is a large muscle. Its origin from 
the cervical vertebrae is nearer to the spine than the 
trachelo-mastoideus; it is covered by the splenius; but 
a large portion of it is seen between the splenius and 
spine, immediately on removing the trapezius. 

Use. To draw the head backward, and to one side. 

On removing the complexus from the occiput, we find, 
close to the spine, 

16. The Semi-Spinalis Colli. — It arises, by dis- 
tinct tendons, from the transverse processes of the six 
superior dorsal vertebrae, ascends obliquely close to the 
spine, and is 

Inserted into the spinous processes of all the vertebrae 
of the neck, except the first and the last. 

Situation. This muscle is situated close to the vertebrae 
at the posterior part of the neck and back. 

Use. To extend the neck obliquely backward. 

17. Semi-Spinalis Dorsi — Arises, from the trans- 
verse processes of the seventh, eighth, and ninth verte- 
brae of the back, by distinct tendons, which soon grow 
fleshy. 

Inserted, by distinct tendons, into the spinous pro- 
cesses of the five superior dorsal vertebrae, and of the 
two lower cervical. 

Situation. This muscle lies nearer the spine than the 
lower part of the semi-spinalis colli; its inferior origins 
lie on the outside of the insertion of the spinalis dorsi. 

Use. To extend the spine obliquely backward. 

The removal of the complexus brings also in view 
several small muscles situated at the superior part of the 
neck, immediately below the occiput. 

18. The Rectus Capitis Posticus Major — Arises, 
fleshy, from the side of the spinous process of the den- 
tata, or second cervical vertebrae. It ascends obliquely 
outward, becoming broader, and is 



MUSCLES OF THE BACK. 



273 



Inserted, tendinous and fleshy, into the inferior trans- 
verse ridge of the os occipitis, and into part of the con- 
cavity above that ridge. 

Situation. This muscle is situated obliquely between 
the occiput and the second vertebrae of the neck. 

Use. To extend and pull the head backward, and to 
assist in its rotation. 

19. The Rectus Capitis Posticus Minor — Arises, 
tendinous and narrow, from an eminence in the middle 
of the back part of the atlas, or first cervical vertebra. 
It becomes broader, and is 

Inserted, fleshy, into the inferior transverse ridge of 
the os occipitis, and into the surface betwixt that ridge 
and the foramen magnum. 

Situation. It is partly covered by the rectus capitis 
posticus major. 

Use. To draw the head backward. 

Fig. 98. 



1. Rectus Capitis Posticus 

Minor. 

2. Rectus Capitis Posticus 

Major. 

3. Obliquus Capitis In- 

ferior. 

4. Obliquus Capitis Su- 

perior. 

5. Interspinals. 




20. Obliquus Capitis Superior — Arises, tendin- 
ous, from the upper and posterior part of the transverse 
process of the first cervical vertebra. 

Inserted, tendinous and fleshy, into the inferior trans- 
verse ridge of the os occipitis behind the mastoid pro- 

13 



274 PRACTICAL ANATOMY. 

cess, and into a small part of the surface above and 
below that ridge. 

Situation. This muscle is situated laterally between 
the occiput and atlas. 

Use. To draw the head backward, and to assist in 
rolling it. 

21. Obliquus Capitis Inferior — Arises, tendinous 
and fleshy, from the side of the spinous process of the 
dentata or second cervical vertebra. It forms a thick 
belly, and is 

Inserted into the under and back part of the trans- 
verse process of the atlas. 

Situation. This muscle is obliquely situated between 
the first two vertebrae of the neck. 

Use. To rotate the head, by turning the first vertebra 
upon the second. 

22. The Multifidus Spinje. 

On removing the muscles of the spine which have been 
described, we find situated beneath them the Multifidus 
Spinae. It is that mass of muscular flesh which lies close 
to the spinous and transverse processes of the vertebrae, 
extending from the dentata to the os sacrum. The 
bundles of which it is composed seem to pass from the 
transverse, to be inserted into the spinous processes. 

Arises, tendinous and fleshy, from the spinous pro- 
cesses and back part of the os sacrum, and from the pos- 
terior adjoining part of the os ilium; from the oblique 
and transverse processes of all the lumbar vertebrae; 
from the transverse processes of all the dorsal vertebrae ; 
and from those of the cervical vertebras, excepting the 
three first. The fibres arising from this extensive origin 
pass obliquely to be 

Inserted, by distinct tendons, into the spinous pro- 
cesses of all the vertebrae of the loins and back, and into 
those of the six inferior vertebrae of the neck. The fibres 
arising from each vertebra are inserted into the second 
one above it, and sometimes more. 

Use. To extend the back obliquely, or move it to one 
side. When both muscles act, they extend the vertebrae 
backward. 



MUSCLES BETWEEN THE RIBS. 275 

The small muscles situated between the processes of 
the vertebrae are: 

1. Intesrpinales colli, dorsi, et lumborum. These 
are small bundles of fibres, which fill up the spaces be- 
tween the spinous processes of the vertebrae. Each of 
these little muscles arises from the surface of one spinous 
process, and is inserted into the next spinous process. 

In the neck they are large, and appear double, as the 
spinous processes of the cervical vertebrae are bifurcated. 
In the back and loins they are indistinct, and are rather 
small tendons than muscles. 

Use. To draw the spinous processes nearer to each 
other. 

2. The Intertransversales colli, dorsi, et lumborum 
are small muscles which fill up, in a similar manner, the 
space between the transverse processes of the vertebrae. 
In the neck they are bifurcated and distinct, in the back 
they are small and slender, and in the loins they are 
strong and fleshy. 

Use. To draw the transverse processes toward each 
other. 



CHAPTER XVI. 

DISSECTION OF THE MUSCLES SITUATED BETWEEN THE 
RIBS, AND ON THE INNER SURFACE OF THE STERNUM. 

The muscles which fill up the space between the ribs 
are named Intercostals; they are disposed on each side 
of the thorax in two layers, and each layer consists of 
eleven muscles. 

1. The Intercostales Externi — Arise from the in- 
ferior acute edge of each superior rib, extending from 
the spine to near the junction of the ribs with their car- 
tilages. The fibres run obliquely forward and down- 
ward, and are 

Inserted into the upper obtuse edge of each inferior 
rib, from the spine to near the cartilage of the rib. 



276 PRACTICAL ANATOMY. 

Situation. These muscles are seen, on removing the 
muscles which cover the thorax. 

The Levatores Costarum are twelve small muscles, 
situated on each side of the dorsal vertebrae. They are 
portions of the external intercostals. Each of these 
small muscles arises from the transverse process of one 
of the dorsal vertebrae, and passes downward, to be in- 
serted into the upper side of the rib next below the ver- 
tebrae, near its tuberosity. 

The first of these muscles passes from the last cervical 
vertebra, the eleven others from the eleven superior 
dorsal vertebrae. The three or four inferior Levatores 
are longer, and run down to the second rib below T the 
transverse process from which they arise. 

2. The Intercostales Interni — Arise from the in- 
ferior acute edge of each superior rib, beginning at the 
sternum, and extending as far as the angle of the rib. 
The fibres run obliquely downward and backward, and 
are 

Inserted into the superior obtuse edge of each inferior 
rib from the sternum to the angle. Portions of the in- 
ternal intercostals pass over one rib, and are inserted 
into the next below it. 

Thus the intercostal muscles decussate, and are double 
on the sides of the thorax ; but, from the spine to the 
angles of the ribs, there are only the external inter- 
costals, and, from the cartilages to the sternum, only 
the internal and some cellular membrane covering them. 
The, whole of the internal intercostals, and the back 
part of the external, are lined by the pleura. 

Use. To elevate the ribs so as to enlarge the cavity 
of the thorax. 

One pair of muscles is situated on the inner surface 
of the sternum. 

The Triangularis Sterni, or Sterno-Costalis — 
Arises j tendinous and fleshy, from the edge of the whole 
cartilago-ensiformis, and from the upper edge of the 
lower half of the middle bone of the sternum. The 
fibres ascend obliquely upward and outward, and form a 
flat muscle, which is 



DISSECTION OF THE EYE. 277 

Inserted, by three or four triangular fleshy and ten- 
dinous terminations, into the cartilages of the third, 
fourth, fifth, and sixth ribs. 

Situation. This muscle lies on the inside of the ribs 
and sternum, and is lined by the pleura. 

Use. To depress the cartilages and the bony extrem- 
ities of the ribs, and consequently to assist in lessening 
the cavity of the thorax. 



CHAPTER XVII. 

DISSECTION OF THE EYE. 

The eyes of inferior animals, as the bullock's, sheep's, 
or pig's, are generally used for purposes of dissection. 1 

The Ball of the Eye — composed of tunics and 
humors. The anterior part is covered by a mucous 
membrane, the Conjunctiva, which is reflected upon 
the eyelids. Clear away all loose structure, and you 
expose 

The Sclerotic Coat — an exceedingly strong fibrous 
coat. It is perforated behind by several small openings 
for the filaments of the optic nerve, and in front has 
connected with it the cornea. 

The Cornea — a transparent membrane, made up of 
numerous laminae. The conjunctiva covers it, though 
altered very much in character. Make an incision 
through the sclerotica, and, introducing a blowpipe, 
force in sufficient air to separate it from the coat be- 
neath; then carefully, with a pair of scissors, divide 
around its entire circumference. This accomplished, 
make a number of antero-posterior incisions, and turn 
back the cut portions, under which the ciliary nerves 
will be seen running forward. 

1 They should be floated in a saucer of water when being examined. 



278 



PRACTICAL ANATOMY. 



Tunica Choroidea — a dark coat, depending for its 
color upon a layer of pigment cells. This coat is very 
vascular. Where it seems to terminate in front, a white 
line is seen, the Ciliary Ligament. In front of it is 
placed the Iris, and, if this be now torn away, a number 



Fig. 99. 




Dissection of the Eye, in which the Sclerotica has been dis- 
sected OFF AND TURNED DOWN IN ORDER TO EXPOSE THE NERVES 
AND SOME OF THE BLOODVESSELS. 

1, 1. Ciliary Nerves entering the Ciliary Ligament and passing for- 
ward to the Iris. The Ligament is dissected away in two 
places to show their course. 

2. Smaller Ciliary Nerve. 

3. Vasa Vorticosa, or Veins of the Exterior Layer of the Choroid. 

4. Ciliary Ligament and Muscle. 

5. Converging Fibres of the Greater Circle of the Iris. 

6. Looped and knotted form of these Fibres near the Pupil, the 

knots or enlargements being regarded as Ganglia by Meckel. 
Within them is seen the lesser circle, Sphincter Iridis, with 
its Converging Fibres. 
6. The Optic Nerve. 

of vascular fringes will be seen on its front border. 
These are the ciliary processes. 



DISSECTION OF THE EYE. 



279 



Fig. 100. 

Internal View of the Choroid Coat and Ciliary Processes, as 
seen in a Vertical Section of the Eyeball. 



a, b. Corona Ciliaris, or Ciliary Body, the rays 
of which are adherent to the Choroid 
at 6, and free at a. 
s. Sclerotic Coat, 
c. Choroid Coat. 



The Ciliary Ligament is a line of union between 
the iris with the choroidea, and these again with the 
sclerotica and cornea. • 

Iris — a muscular and vascular body, consisting of 
fibres longitudinal and circular. It is colored with pig- 
mentum nigrum, and the opening in it is the pupil. 





A Horizontal Section of the Eye. 



1, 1. The Cornea, fitted into the Sclerotica. 

2. Its Posterior Lamina, or Cornea Elastica, forming the An- 
terior Parietes of the Chamber for the Aqueous Humor. 

3, 3. Sclerotic Coat. 

4, 4. Choroid Coat. 



280 PRACTICAL ANATOMY. 

5, 5. Ciliary Ring or Ligament. 

6. Its Internal Surface, corresponding to the Ciliary Processes. 

7. Ciliary Body, or Corona Ciliaris of the Choroid Coat. 

8. The Iris. 

9. Posterior Chamber of the Aqueous Humor. 

10. Anterior Chamber of the Aqueous Humor. 

11. The Retina. 

12, 12. Termination of the Retina (according to Cruveilhier and 
others, margo dentatus), at the Posterior Extremities of the 
Ciliary Processes of the Vitreous Body. 

12. The Vitreous Humor. 

13. The Hyaloid Tunic, one layer of which passes behind. 

14. The other in front of the Crystalline Lens. 

15. The Lens. 

16 Canal of Petit. 

17. Optic Nerve, invested by a Sheath from the Dura Mater. 

18. Vitreous Humor, or Corpus Vitreum. 

Retina. — If the choroid be dexterously removed, 
the retina is exposed, an exceedingly delicate nervous 
membrane. 1 It is connected in front to the lens by its 
vascular layer, the Zonula Ciliaris. 

There are three humors or lenses in the interior of 
the eye. 

Vitreous Humor — makes the great bulk of the eye, 
and is situated posteriorly. 

It is inclosed in a delicate capsule, the Hyaloid Mem- 
brane. 

Crystalline Humor is a double convex lens, situated 
on the front part of the vitreous humor, and inclosed in 
a membrane called its capsule. 

Aqueous Humor — it has the least consistence of the 
three, and occupies all the space between the crystalline 
lens behind and the cornea in front, filling up the ante- 
rior and posterior chambers of the eye. The communi- 
cation between the two chambers of the eye is the pupil. 



1 For its structure and that of the other coats, see works on spe- 
cial anatomy. 



LIGAMENTS. 281 



CHAPTER XVIII. 



LIGAMENTS. 



If the student designs examining the articulations, 
they should be kept moist after the dissection of the 
muscles. 

The Ligaments are found either in the form of cords, 
bands, or sacs. The most perfect capsular ligaments 
are those of the shoulder and hip-joints. 

Within the ligaments of movable articulations is a 
lining of serous membrane. The synovial sac which se- 
cretes a tenacious viscid fluid, the Synovia; designed 
for lubrication of the joints. The student should exam- 
ine the most important articulations, of which the fol- 
lowing may be described : 

Articulation of the Lower Jaw, 

It is formed between the glenoid cavity of the tem- 
poral bone and the head of the inferior maxillary bone. 

A Capsular Ligament invests the joint, arising 
around the glenoid cavity, and inserted about the neck 
of the inferior maxillary bone. A few additional fibres 
on the inner and outer side of the capsular ligament 
have been named the Internal and External Late- 
ral Ligaments. 

Stylo-maxillary Ligament — Arises from the sty- 
loid process, and is inserted on the posterior face of the 
jaw, close to the angle. 

Interarticular Cartilage divides the capsular lig- 
ament, and it is seen placed between the condyle and the 
glenoid cavity. Usually there are two distinct synovial 
sacs, one above and one below this cartilage. 

13* 



282 



PRACTICAL ANATOMY. 



Fig. 102. 
Articulations of the Lower Jaw. 




1. External Lateral Ligament. 

2. Internal Lateral Ligament. 

3. Interarticular Cartilage. 



Ligaments of the Spine. 

Anterior Vertebral Ligament extends along the 
front of the spine from the second vertebra to the sa- 
crum. 

Posterior Vertebral Ligament extends from the 
foramen magnum to the sacrum and coccygis, on the 
posterior part of the bodies of the vertebrae, within the 
spinal canal. 

Intervertebral Substance. — Fibrocartilaginous 
disks placed between all the vertebra except the first 
two. They consist of an exterior part, the fibres of 
which are arranged concentrically, and also oblique, and 
an interior, consisting of a soft pulpy substance, This 
material is, in the connected spine, in a state of com- 
pression, as it is seen to rise up when the contiguous 
pieces are removed. The Oblique Processes are con- 
nected by capsular ligaments, lined by synovial mem- 
branes. The spinous processes have ligaments passing 
between them. Between the bony bridges of the ver- 



LIGAMENTS. 



283 



tebrre are placed the ligamenta subflava, or yellow elas- 



tic ligaments 



Special Articulations of the Spine. 

Of the Occiput with the Atlas. — The articulating 
processes of each are faced with cartilage, and sur 
rounded by a capsular ligament. 

Fig. 103. 



1. Occiput. 

2. Posterior Occipito - at- 

loidean Ligament. 

3. Posterior Atloidean 

Dentate Ligament. 

4. 4. Second Pair of Yel- 

low Ligaments. 




Occipito-Atloidean Ligament — Arises from the 
margin of the great occipital foramen, and is inserted 
into the upper margin of the Atlas. 



Articulation of the Axis with the Occiput. 

Occipito-Dentate Ligament — From the processus 
dentatus to the front of the great occipital foramen. 

Transverse Ligament stretches across from one 
side to the other of the first vertebra, just behind the 
processus dentatus. 

Moderator Ligaments — Two in number, and ex- 
tend from the processus dentatus to the inner part of 
the occipital condyles. 



284 



PRACTICAL ANATOMY. 



Fig. 104. 
The Posterior Arch of the Occiput and Two Upper Vertebra. 



1. Basilar Process. 

2. Anterior Condyloid 

Foramen. 

3. Posterior Foramen 

Lacerum. 

4. Transverse Ligament 

of the Atlas. 

5. Its Superior Fascicu- 

lus. 

6. Its Inferior Fascicu- 

lus. 

7. Anterior Vertebral 

Ligament. 




Principal Ligaments of the Pelvis. 

Those connecting the sacrum to the vertebra are 
called Sacro-Vertebral. 

The Coccygeal Ligaments, Anterior and Poste- 
rior, are placed in front and behind the coccyx. 

Ilio-Lumbar Ligament — From the transverse and 
oblique processes of the last lumbar vertebra, to the 
posterior part of the crest of the ilium. 

Sacro-Iliac Ligaments — Bands of fibres which sur- 
round the sacro-iliac junction. 

Posterior Sacro-sciatic - Ligament — From the 
posterior inferior spinous process of the ileum, from the 
sacrum and coccyx, to the inner part of the tuberosity 
of the ischium, and continued toward the pubis. 

Anterior Sacro-sciatic Ligamenx — From the sa- 
crum and coccyx to the spinous process of the ischium. 

Obturator Ligament fills up the foramen thy- 
roideum. 

Articulation of the Pubes. 

Between the bodies of the pubes, fibro-cartilage, and 
in front, bands of fibres passing across from one bone 
to the other. 



LIGAMENTS. 
Fig. 105. 



285 




Articulation of the Pelvis and Hip. 



1. Posterior Sacro-sciatic Liga- 

ment (Vertical Ligament of 
Bichat), arising from the 8a- 
cro-iliac Junction. 

2. Also from the Sacrum and 

Coccyx. 

3. Free portion of the Ligament, 

inserted into the Tuber Is- 
chii at 4 and 5. 

6. Lesser or Anterior Sacro-sci- 

atic Ligament. 

7. Obturator Ligament. 



8. Os Coccygis. 

9. Sacral Fasciculus of the 

Posterior Sacro-Sciatic 
Ligament. 
10, 11. Capsular Ligament of the 
Hip-joint. 

12. Trochanter Minor. 

13. Trochanter Major. 

14. Lesser Sciatic Notch. 

15. Greater Sciatic Notch. 

16. Posterior Sacro-iliac Lig- 

ament. 



Subpubic Ligament placed beneath the arch of the 
pubes. 

Posterior Articulations of the Ribs. 

The ribs are connected to the bodies of the vertebrae 
and intervertebral cartilages by an interarticular liga- 
ment, and an anterior one ; and to the transverse pro- 



286 



PRACTICAL ANATOMY. 



cesses by ligaments called Costotransverse Liga- 
ments. 

Anterior Articulation of the Ribs. 

The ribs have small cavities on their anterior extrem- 
ities, into which fits the corresponding cartilage, and 
strengthened by fibrous bands in front and behind; 

The cartilages of the true ribs are let into cavities in 
the sternum, and strengthened by radiated fibres in 
front. 

Sterno- Clavicular Articulation. 

The end of the clavicle is placed in a cavity on the 
edge of the sternum ; a strong cartilage interposed, and 
the whole articulation incased in a capsular ligament. 

Fig. 106. 




Sterno-claviculae, Articulation. 



1. Capsular Ligament. 

2. Inter-clavicular Ligament. 

3. Costo-clavicular or Rhomboid 

Ligament. 



4, 4. Clavicles. 

5, 6. Costo-sternal or Chondro- 

sternal Ligaments. 



The clavicle is connected also to the first rib or its car- 
tilage, the Costo-clavicular or Rhomboid Ligament. 



ARTICULATIONS. 



287 



Scapulo- Clavicular Articulation. 

The Acromioclavicular Ligament. — A capsular 
ligament investing the acromion process and the acro- 
mial end of the clavicle. 

Coraco-clavicular Ligament between the coracoid 
process of the scapula and the first rib. It presents the 
appearance of two, which have been named the Conoid 
and Trapezoid Ligaments. 

Coraco-acromial Ligament between the coracoid 
and acromion processes. 

Coracoid Ligament across the coracoid notch. 

Scapulo-humeral Articulation. 

Glenoid Ligament around the glenoid cavity of the 
scapula in order to deepen it. 

Fig. 107. 




Scapulo-humeral Articulation. 

1. Ligamentum Bicorne. 

2. Acromio-clavicular Ligament. 

3. Coraco-acromial Ligament 

4. Coraco-clavicular Ligament. 

5 Coracoid or supra scapular Ligament. 

6. Capsular Ligament. 

7. Tendons of the Supra-spinatus, Infra-spiuatus, 

Minor Muscles. 

8. Tendon of the Long Head of the Biceps. 



and Teres 



288 PRACTICAL ANATOMY. 

Capsular Ligament between the margin of the gle- 
noid cavity and the neck of the humerus. 

Accessory Ligament. — A simple thickening of the 
capsular ligament between the coracoid process and the 
great tuberosity of the humerus. 

The tendon of the biceps muscle passes through the 
upper part of the cavity on its way through the bicipital 
groove to the arm. 

Elbow-Joint. 

Capsular Ligament arising from the margin of the 
articular surface of the os humeri and inserted into the 
ulna and coronary ligament of the radius. A thicken- 

Fig. 108. 




8 

The Humero-cubital Articulation. 

1. External Lateral Ligament, blended with the Extensor 
Tendons. 
2, 3, 4, 5. Capsular Ligament. 

6. Tendon of the Biceps. 

7. Humerus. 

8. Ulna. 

9. Radius. 

ing of its fibres on the inner and outer side of the ar- 
ticulation constitutes the External and Internal La- 
teral Ligaments. 



ARTICULATIONS. 289 

Coronary Ligament of Radius passes from one 
side of the lesser sigmoid cavity of the ulna to the other. 
It embraces the neck of the radius. 

Interosseous Ligament, a fibrous membrane 
stretched between the radius and ulna. 

Round Ligament, from the coronoid process to the 
radius below its tubercle. 

Articulation of the Wrist. 

This includes the connection of the radius and ulna 
below; the first row of the carpus with these; and the 
two rows of the carpus with each other. 

Madio-ulnar Articulation. 

A triangular cartilage extends from the side of the 
radius, and is fixed by a pointed process into the root of 
the styloid process of the ulna. This cartilage sepa- 
rates the lower end of the ulna from the cuneiform bone. 
The capsule of fibrous tissue which connects these bones 
above the cartilage is loose-lined with a synovial mem- 
brane, and called the Sacciform Ligament. The car- 
tilage is often perforated by an opening, and the syno- 
vial membrane is continuous above and below. 

Radio-carpal Articulations. 

Formed between the radius and the first three bones 
of the first carpal row ; it is effected by an Anterior 
and Posterior Radio-carpal Ligament, and the Ex- 
ternal and Internal Lateral Ligament. The late- 
ral ones arising from the styloid processes of the radius 
and ulna, and inserted into the scaphoid, trapezium, and 
cuneiform bones. 

Articulations of the Bones of the Carpus. 

These bones are arranged in two rows, having a com- 
mon synovial membrane, except the pisiforme, and that 
between the trapezium and the metacarpal bone of the 



290 



PRACTICAL ANATOMY. 



thumb. The figure will explain. Ligamentous bands 
run in different directions from one bone to the other. 



Fig. 109. 

Articulations of the Bones of the Carpus with each other, 
and with those of the forearm and metacarpus. 

1. Scaphoides. 

2. Lunare. 

3. Cuneiforme. 

4. Pisiforme. 

5. Trapezium. 

6. Trapezoides. 

7. Magnum. 

8. Unciforme. 

9. Radius. 

10. Ulna. 

11. Synovial Membrane of the 
Inferior Radio-ulnar Ar- 
ticulation. 

12. Synovial Membrane of the 
Radio-carpal Articula- 
tion. 

13. Inter- articular Ligament 
between the Ulna and 
Radius, and separating 
the two preceding Syno- 
vial Membranes. 

Synovial Membrane of the Os Pisiforme. 

Synovial Apparatus between the First and Second Rows of 
Carpal Bones, and between the Second Row and the Meta- 
carpus. 

Synovial Membrane of the Articulation of the Os Trapezium 
with the First Metacarpal Bone. 




14. 
15, 15. 



16. 



The Phalangeal Articulations 

may be considered as Capsular Ligaments thickened 
very much on their sides, forming the Lateral Liga- 
ments, and strengthened in front and on the back by 
the sheath for the flexor tendons and the expansion of 
the extensor tendons. 



Articulations of the Hip- Joint. 

It occurs between the acetabulum and the head and 
neck of the femur. 



ARTICULATIONS. 



291 



Capsular Ligament — arising from about the aceta- 
bulum, and inserted into the neck of the femur, lower 
in front than behind. 

Fig. 110. 
View of the Capsular Ligament of the Hip-joint. 



1. The Capsular Ligament 

is separated from the 
Acetabulum, and is 
thrown back to show 
the manner in which 
it invests and con- 
ceals the neck of the 
Femur. 

2. Ligamentum Teres. 




Ligamentum Teres — a round cord from the pit on 
the head of the femur to the sides of the notch of the 
acetabulum. 

Cotyloid Ligament — surrounds the brim of the 
acetabulum as far as the notch. 

Transverse Ligament— subtends the notch of the 
acetabulum. The student will observe a loose vascular 
pad of fat filling up a little space in the bottom of the 
acetabulum. These masses were once considered as 
glands. 

The Knee- Joint. 

An expansion from the tendons of the muscles of the 
thigh incloses this articulation in a loose bag of fibrous 
tissue. 



292 



PRACTICAL ANATOMY. 



Fig. 111. 
Front View of the Knee-Joint. 




1. Ligamentum Patellae. 

2. Internal Lateral Ligament. 
8. External Lateral Ligament. 



The Involucrurn. 

External Lateral Ligament — from the external 
condyle to the head of the fibula. 

Internal Lateral Ligament — from the internal 
condyle of the femur, some distance along the head and 
upper part of the shaft of the tibia. 

In front of the articulation is placed the patella, con- 
nected by the Tendo Patellje to the tubercle of the 
tibia. 

Ligament of Winslow — a derivation from the ten- 
don of the semimembranosus muscle, passing to the 
back part of the capsular ligament and giving it in- 
creased strength. If the patella be turned off the front 
of the joint, a mass of fat is seen filling up the space 
between the condyles of the femur and the head of the 
tibia. A ridge of synovial membrane on each side of 
this forms the Alar Ligaments. From their junction 
above starts another duplicature of synovial membrane 
back to the crucial ligaments. This is the Ligamentum 
Mucosum. 



ARTICULATIONS. 
Fig. 112. 



293 




A Longitudinal Section of the Left Knee-Joint, showing the 
Reflection of its Synovial Membrane. 



1. The Cancellated Structure of the lower part of the Femur. 

2. The Tendon of the Extensor Muscles of the Leg. 

3. The Patella. 

4. Ligament of the Patella. 

5. The Cancellated Structure of the Head of the Tibia. 

6. A Bursa situated between the Ligament of the Patella and the 

Head of the Tibia. 

7. The Mass of Fat projecting into the Cavity of the Joint below 

the Patella. ** The Synovial Membrane. 

8. The Pouch of the Synovial Membrane, which ascends between 

the Tendon of the Extensor Muscles of the Leg and the Front 
of the Lower Extremity of the Femur. 

9. One of the Alar Ligaments. The other has been removed with 

the opposite section. 

10. The Ligamentum Mucosum left entire — the Section being made 

to its inner side. 

11. The Anterior or External Crucial Ligament. 

12. The Posterior Ligament. The scheme of the Synovial Mem- 

brane, which is here presented to the student, is divested of 
all unnecessary complications. It may be traced from the 
Sacculus (at 8) along the inner surface of the patella; then 
over the adipose mass (7), from which it throws off the Mu- 
cous Ligament (10) ; then over the head of the Tibia, form- 
ing a sheath to the Crucial Ligaments ; then upward along 
the Posterior Ligament and Condyles of the Femur to the 
Sacculus, where its examination commenced. 



294 PRACTICAL ANATOMY. 

Crucial Ligaments, Anterior and Posterior — 
the first from the inner face of the external condyle, 
and inserted in front of the spinous process of the tibia ; 
the last from the inner face of the internal condyle of 
the femur, and inserted behind the same process of the 
tibia. 

Semilunar Cartilages — two in number, between 
the femur and tibia. Their posterior and anterior ends 
are fixed behind and in front of the spinous process of 
the tibia. Notice the extent of the synovial membrane 
above the patella. 

Peroneo-tibial Articulations. 

The upper end of the fibula is connected to the tibia 
by a capsular ligament thick in front, and behind form- 
ing the Anterior and Posterior Peroneo-tibial 
Ligaments. At the lower end in the same manner, but 
called there the Anterior and Posterior Inferior 
Peroneo-tibial Ligaments. 

Transverse Ligament — extends between the two 
malleoli on the posterior aspect of the joint. 

Interosseous Ligament — fills up the space between 
the shafts of the two bones. 

The Ankle-Joint. 

Constituted by the tibia, fibula, and astragalus. On 
the front and behind the joint there exists only the ap- 
pearance of a capsular ligament, but on the sides we 
have the Lateral Ligaments. 

The External Lateral Ligament consists of three 
fasciculi, arising from the external malleolus, and is in- 
serted into the astragalus and the os calcis. 

Internal Lateral Ligament — Arises from the in- 
ternal malleolus, and is inserted into the lesser apophy- 
sis of the os calcis. It spreads out toward its insertion, 
hence sometimes called the Deltoid Ligament. 



ARTICULATIONS. 
Fig. 113. 



295 




Inteenal Ligaments of the Ankle and Foot. 

1. Anterior Fasciculus of the Deltoid Ligament. 

2. Middle Fasciculus. 

3. Posterior Fasciculus. 

4. Groove for the Flexor Digitoruin Communis. 

5. Internal Calcaneo-scaphoid Ligament. 

6. Tendon of the Tibialis Posticus. 

7. Tendon of the Tibialis Anticus. 

8. Ligament connecting the Os Scaphoides with the first Cuneiform 

Bone. 

9. Ligament connecting the Scaphoides with the Cuneiform Me- 

dium. 
10. Ligaments connecting the first Metatarsal with the first Cunei- 
form Bone. 



Articulations of the Os Calcis and Astragalus. 

A very powerful interosseous ligament forms the 
principal one. 

Scaphoid and Astragalus — united by a capsular 
ligament. 

Os Calcis and Cuboides — united by the superior 
and inferior calcaneo-cuboid ligaments passing between 
the two bones. 



296 



PRACTICAL ANATOMY. 
Fig. 114. 




7 8 
The External Lateral Ligaments of the Ankle and Foot. 

1. Anterior Ligament of the Lower Tibio-fibular Articulation. 

2. External Lateral Ligament, sometimes called Peroneo-calcaneum. 

3. Anterior Fasciculus of the same, or Peroneo-astragalian Liga- 

ment. 

4. External Calcaneo-astragalian Ligament. 

5. Interosseous Ligament. 

6. Lower Calcaneo-cuboid Ligament. 

7. Ligament (Ligamentum Dorsale Obliquum), uniting the Fifth 

Metatarsal Bone with the Os Cuboides. 

8. Dorsal Ligament of the Fourth Metatarsal Bone. The dorsal sur- 

face of the foot is covered by smaller ligaments that connect 
the tarsal and metarsal bones, and these again with each other. 

The Os Calcis and Scaphoid are very firmly united 
by the internal and external Calcaneo-Scaphoid Lig- 
aments — the former from the lesser apophysis of the os 
calcis to the inner surface of the scaphoid ; the latter 
from the greater apophysis of the os calcis to the outer 
end of the scaphoid. Other ligaments, both on the 
upper and lower surface of the foot, connect the differ- 
ent pieces together. 



INDEX. 



Abdomen, 140. 

arteries of, 141. 

superficial fascia of, 141. 
Abdominal regions, 141. 

ring, external, 142. 
internal, 148. 
Acervulus, 42. 
Air-cells, 251. 
Alimentary canal, 150. 
Amygdalae, 46, 78. 
Antihelix, 12. 
Antitragus, 13. 
Anus, 159. 
Aortic sinuses, 261. 
Appendices epiploicae, 159. 
Appendix vermiformis, 159. 
Aqueduct of Sylvius, 42. 
Aqueous humor, 280. 
Arachnoid membrane, 35. 
Arbor vitae, 46. 
Arch, palmar, 135. 
Arytenoid cartilages, 84. 
Auricles of heart, 260. 
Axilla, 93, 97. 
Axis, coeliac, 167. 
Arteries — 

ad cutem abdominis, 141. 

alveolar, 24. 

anastomoticabrachialis, 133. 
femoralis, 182. 

angular, 19. 

aorta, 167, 247, 249, 255, 
258. 

arcus sublimis, 135. 

profundus, 130, 135. 

articular, 205. 

auricular posterior, 66. 

axillary, 97. 

basilar, 47. 



14 



Arteries — continued. 

brachial, 118, 131, 134. 
bronchial, 256. 
bulbosi, 225, 231. 
callosae, 37. 
carotid, common, 65, 250. 

external, 23, 68. 

internal, 49, 56. 
carpal, radial, 116, 138. 

ulnar, 135. 
cavernosi, 225, 231. 
centralis, retinae, 91. 
cerebellar, 52. 

inferior, 52. 

posterior, 52. 

superior, 52. 
cerebral anterior, 52. 

media, 52. 
cervicis superficialis, 74. 

princeps, 74. 

profunda, 74. 
circumflex femoral, 185. 

humeral, anterior and 
posterior, 98. 

ilii, 147, 150. 
coeliac axis, 167. 
colica dextra, 169. 

media, 169. 

sinistra, 171. 
communicans cerebri, 52. 
coronaria cordis, 261. 

labial, 19. 

ventriculi, 167. 
dental, 19. 
digitalis manus, 116, 136. 

pedis, 213. 
dorsalis carpi, 134, 136. 
dorsalis pollicis, 134. 

hallucis, 194. 

(297) 



298 



INDEX. 



Arteries — continued. 

dorsalis penis, 225, 231, 234. 

scapulse, 98. 
emulgent or renal, 171. 
epigastric, deep, 150, 186. 

superficial, 141. 
facial, 19, 66. 

transverse, 20. 
femoral, 184. 
frontal, 11, 25, 91. 
gastric, 167. 

gastro - epiploica sinistra, 
169. 

dextra, 169. 
gluteal, 201. 

hemorrhoidal, superior, 171. 
hepatic, 169. 
ileo-colic, 169. 
ileo-lumbar, 230. 
iliac, common, 171. 

external, 172. 

internal, 171, 230. 
inferior coronary, 19. 
inferior labial, 19. 
infra-orbital, 16, 25, 91. 
innominata, 250. 
intercostal, 255. 

superior, 75, 255. 
interosseous, leg, 193. 

arm, 116 

pedis, posterior, 124. 
ischiatic, 202, 230. 
labial, 19. 
lachrymal, 27. 
laryngeal, 66. 
lateralis, nasi, 19. 
lingual, 66. 
lumbar, 171. 
malleolar, 193. 
mammary, internal, 74. 

external, 98. 
masseteric, 19. 
maxillary, internal, 24, 67. 

inferior, 24. 
meningea magna, 28. 

anterior, 34. 

media, 33. 

parva, 28. 

posterior, 34. 
mesenteric, superior, 169. 

inferior, 171. 
metatarsal, 193. 
obturator, 186. 



Arteries — continued. 
occipital, 66. 
oesophageal, 256. 
ophthalmic, 91. 
pancreaticae, 169. 
parotidean, 20. 
perforantes, 185, 213. 
perineal, superficial, 231. 

transverse, 224. 
peroneal, 213. 
pharyngeal, 24, 66. 
phrenic, 167. 
plantar, 211. 
plantar superior, 75. 
plantar arch, 211. 
popliteal, 205. 
posterior occipital, 11. 

auricular, 11. 
princeps cervicis, 74. 
profunda cervicis, 74. 

femoris, 184. 

humeri, superior, 132. 
inferior, 133. 
pterygoid, 24. 
pudic external, 186. 

internal, 224, 225, 230. 
pulmonary, 247. 
pyloric, 169. 
radial, 115, 133. 

indicis, 135. 

recurrent, 116, 134. 
renal, 171. 
sacral lateral, 230. 

media, 171. 
scapular, supra, 74. 

posterior, 74. 
spheno-palatine, 24. 
splenic, 169. 
subclavian, 72, 250. 
subscapular, 94. 
submental, 62, 66. 
superficialis voire, 116, 133. 
superficial circumflex ilii, 

186. 
supra- orbital, 11. 

scapular, 74. 
sural, 205. 
spermatic, 171, 233. 
tarsal, 193. 
temporal, 11, 67. 

deep, 24. 
tibial anterior, 192. 

posterior, 205, 211. 



INDEX. 



299 



Arteries — continued. 

tibial, anterior recurrens, 

192. 
transverse facial, 20, 67. 
thoracic acromial, 98. 
thoracic superior, 98. 
thoracico humeralis, 94. 
thyroidea, superior, 65. 

inferior, 72. 

axillary, 98. 

axis, 72. 

humeral, 94. 

longa, 98. 
ulnar, 116, 135. 

recurrens, 136. 
umbilical, 150. 
vasa brevia, 169. 
vertebral, 52, 74. 

Bladder, 243. 
Brain, 32. 

cortical part of, 36. 

hemispheres of, 36. 

lobes of, 36. 

medullary part of, 36. 
Bronchige, 251. 
Brunner's glands, 161. 
Bulb of urethra, 226, 236. 

Caecum, 159. 
Calamus scriptorius, 45. 
Capsule of Glisson, 155. 
Capsules, supra-renal, 162. 
Caput gallinaginis, 235. 
Cartilage, interarticular clavicle, 
288. 

arytenoid, 84. 

cornicula laryngis, 84. 

cricoid, 84. 

cuneiforme, 85. 

epiglottis, 84. 

of jaw, 281. 

of wrist, 289. 

semilunar, 24. 

thyroid, 84. 
Caruncula lachrymalis, 91. 

myrtiformes, 238. 
Cauda equina, 53. 
Centrum ovale majus, 38. 

minus, 38. 
Cerebellum, 36, 45. 
Cerebrum, 36. 
Ceruminous glands, 13. 



Chambers of the eye, 280. 
Chordas tendinese, 260. 

vocales, 87. 

Willisii, 33. 
Choroid, 278. 
Choroid plexus, 44. 
Ciliary ligament, 279. 
Circle of Willis, 49. 
Clitoris, 237, 238. 
Colon, 151, 159. 
Columnse carneae, 260, 
Columna nasi, 31. 
Columns of abdominal ring, 142. 
Columns of spinal cord, 53. 
Commissures of brain, 41. 
Concha, 12. 
Conjoined tendon, 148. 
Conjunctiva, 277. 
Cordiform tendon, 163. 
Cornea, 277. 

Cornua of the ventricles of brain, 
38. 

ammonis, 44. 
Corpora albicantia, 44. 

arantii, 260. 

cavernosa, 227. 

geniculata, 41. 

olivaria, 47. 

pyramidalia, 47. 

quadrigemina, 42. 

restiformia, 47. 

striata, 41. 
Corpus callosum, 27. 

fimbriatum, 44. 

dentatum, 44. 

psalloides, 39. 

spongiosum, 226. 
Cowper's glands, 226. 
Cranial nerves, 49. 
Cricoid cartilage, 84. 
Crura cerebelli, 47. 

cerebri, 47. 

penis, 227. 
Crural arch, 144. 

canal or ring, 166. 
Crystalline lens, 280. 

Dartos, 236. 
Dissecting wounds, 10 
Ductus ad nasum, 91. 

arteriosus, 250. 

communis choledochus, 155. 

cysticus, 155. 



300 



INDEX. 



Ductus ejaculatorius, 235. 

hepaticus, 155. 

lachrymalis, 91. 

pancreaticus, 161. 

parotid, 20. 

prostatic, 236 

thoracic, 173, 256, 259. 

venosus, 155. 
Duodenum, 157. 
Dura mater, 32. 

Ear, 12. 

Endocardium, 258. 
Epididymis, 233. 
Epiglottis cartilage, 84. 
Eustachian tube, 79. 

valve, 258. 
Exocardium, 258. 
Eye, 277. 
Eyelids, 90. 

Falciform process, 176. 

or semilunar edge, 176. 
Fallopian tubes, 241. 
Falx cerebelli, 34, 45. 

cerebri, 34. 
Fascia — 

cervical, 56. 

cribriform, 174 

iliac, 166. 

infundibular, 148. 

intercolumnar, 144. 

intermuscular, 209. 

lata femoris, 174. 

lumbar, 268. 

palmar, 113, 125, 135. 

pectineal, 176. 

pelvic, 228. 

perineal, 221. 

plantar, 214. 

propria, 176. 

sartorial, 176. 

spermatic, 144. 

subaponeurotic, 11. 

temporal, 21. 

transversalis, 148. 
Fauces, 78. 
Fimbriae, 242. 
Fissure cerebri, 41. 

anterior, posterior, median, 
53. 

of the liver, 154. 

of spinal cord, 53. 



| Fissure Sylvii, 36, 47. 
Flocculus, 46. 
Foramen caecum, 81. 

of Monroe, 39. 

of Morgagni, 81. 

of Winslow, 153. 

ovale, 258. 

Thebesii, 258. 
Fornix, 39. 
Fossa, ischio-rectale, 221. 

ovalis, 258. 
Fourchette, 236. 

Gall-bladder, 155. 
Ganglia, cervical, 69. 

Casserian, 50. 

ciliary, 27. 

impar, 173, 525. 

lenticular, 93. 

lumbar, 253. 

semilunar, 173. 

sacral, 256. 
Gimbernat's ligament, 166. 
Glands of Brunner, 161. 

ceruminous, 13. 

Cowper, 225, 226, 236, 239. 

inguinal, 174. 

lachrymal, 90, 94. 

lymphatic, 97. 

mammary, 94. 

mesenteric, 154. 

Pacchionian, 33. 

parotid, 20. 

Peyer, 161. 

pineal, 42. 

prostate, 226. 

pituitary, 49. 

sublingual, 62. 

submaxillary, 60. 

thymus, 250. 

thyroid, 59. 
Glans clitoridis, 237. 

penis, 227. 
Glisson's capsule, 155. 
Glosso epiglottidean, folds, 81. 
Globus major, 233. 

minor, 233. 
Glottis, 84. 
Guthrie's muscle, 225. 

Heart, 245. 
Helix, 12. 
Hernia, 148. 



INDEX. 



301 



Hernia, femoral, 174. 

inguinal, 148. 

ventro-inguinal, 148. 
Hey's ligament, 176. 
Hippocampus major, 44. 

minor, 44. 
Horner's muscle, 91. 
Humors of eye, 280. 
Hyaloid membrane, 280. 
Hymen, 238. 



Ileo-csecal valve, 161. 
Ileum, 157. 
Infundibulum, 47. 
Inguinal canal, 148. 
Intercolumnar fascia, 144. 
Intervertebral substance, 285. 
Intestinal canal, 151, 155. 
Iris, 279. 

Ischio-rectal fossa, 221. 
Isthmus of the fauces, 79. 
Iter ad infundibulum, 42. 

quartum ventriculum, 42, 50. 

Jejunum, 157. 
Joint, ankle, 294. 

elbow, 288. 

hip, 290. 

knee, 292. 

lower jaw, 282. 

shoulder, 287. 

wrist, 290. 

Kidneys, 161. 

Labia majora, 236. 

minora, 237. 
Lachrymal canals, 90. 

caruncle, 91. 

duct, 91. 

gland, 90. 

puncta, 90. 

sac, 91. 
Larynx, 58, 84. 
Lenticular ganglion, 93. 
Ligaments, 28. 

acromio-clavicular, 287. 

alar, 292. 

annular of ankle, 187, 294. 
wrist, 289. 

arcuatum, 163. 

articulation of the ribs, 286. 



Ligaments — continued. 

calcaneo-cuboid superior, 
295. 

inferior, 295. 
calcaneo-scaphoid, internal, 
296. 

external, 296. 
capsular of hip, 291. 

of elbow, 288. 

of jaw, 282. 

of shoulder, 287. 
carpus, 289. 
coccygeal, 284. 
conoid, 287. 
cotyloid, 291. 
coracoid, 287. 
coraco-acromial, 287. 

accessory, 288. 

clavicular, 287. 
coronary, 289. 
costo-clavicular, 286. 

transverse, 286. 
crucial, 294. 
deltoid, 294. 
denticulatum, 53. 
ileo-lumbar, 284. 
interosseous, 289. 
of bladder, 228. 
of elbow-joint, 288. 
of shoulder-joint, 287. 
of the ankle-joint, 294. 
of the hip-joint, 290. 
of the knee-joint, 291. 
of the pelvis, 281. 
of the phalanges, 290. 
of the spine, 282. 
of the wrist-joint, 289. 
occipito axoid, 284. 

atloid, 283. 
Poupart's, 144. 
radio-carpal, 289. 
radio-ulnar, 289. 
sacro-ischiatic, 284. 
sacro-vertebral, 284. 
sterno-clavicular, 286. 
stylo-maxilla, 56, 62. 
tarsal, 294. 
tibio, fibular, 294. 
temporo-maxillary, 281. 
triangular, 221, 225. 
patella, 292. 
phalangeal, 290. 
Ligamentum latum, 241. 



302 



INDEX. 



Ligamentum nuchae, 262. 

teres, 241. 
Linea alba, 142. 

innominata, 148. 

semilunaris, 142. 

transversa?, 142, 149. 
Liver, 154. 

its ligaments, 151, 153. 
Lobus caudatus, 154. 

quadratus, 154. 

Spigelii, 154. 
Locus perforatus, 47. 
Lungs, 245, 248. 
Lyra, 39. 

Mammae, 94. 

Mediastinum, 244. 

Medulla oblongata, 36, 45, 47. 

spinalis, 52. 
Membranous urethra, 236. 
Mescolon, 154. 
Mesentery, 153. 
Mitral valve, 264. 
Mons veneris, 236. 
Monticulus, 45. 
Morsus diaboli, 242. 
Muscles — 

adductor indicis, 132. 
brevis, 182. 
indicis manus, 128. 
longus, 181. 
magnus, 183. 
metacarpi minimi digiti 

manus, 129. 
pollicis manus, 128. 
pollicis pedis, 217. 
abductor minimi digiti pedis, 
215. 
minimi digiti, 129. 
oculi, 92. 

pollicis manus, 126. 
pollicis pedis, 215. 
anconeus, 122. 
accelerators urinae, 222. 
accessorius, 216. 
anterior auris, 12. 
anti-tragicus, 13. 
aryteno-epiglottideus, 87. 
arytenoideus, 85 
atollens aurem, 12. 
auricularis, 124. 
azygos uvulae, 81. 
biceps flexor cruris, 199. • 



Muscles — continued. 

biceps flexor cubiti, 106. 
brachialis anticus, 109. 
buccinator, 17. 
cervicales ascendens, 270. 
circumflexus palati, 84. 
coccygeus, 225, 240. 
complexus, 271. 
compressor naris, 15. 

urethras, 225. 
constrictor isthmi faucium, 
79. 
pharyngis, 82, 83, 86. 
coraco-brachialis, 108. 
corrugator supercilii, 14. 
cremaster, 147, 233. 
crico-arytenoid lateralis, 85. 

posticus, 85. 
crico-thyroideus, 60. 
cruraeus, 180. 
deltoid, 102. 

depressor labii superioris 
alaeque nasi, 19. 
anguli oris, 17. 
labii inferioris, 21. 
oculi, 92. 
diaphragm, 162. 
digastricus, 60. 
erector clitoridis, 239. 
penis, 221. 
spinse, 271, 272. 
extensor carpi radialis bre- 
vior, 120. 
brevis digitorum pedis, 

194. 
digitorum communis, 

120. 
longior, 119. 
longus digitorum pedis, 
188. 
indicis, 124. 
minimi digiti, 120. 
ossis metacarpi pollicis, 

123, 126. 
primii internodii, 123. 
proprius pollicis pedis, 

189. 
secundii internodii, 123. 
ulnaris, 121. 
flexor brevis pollicis manus, 
126. 
minimi digiti pedis, 
217. 



INDEX. 



303 



Muscles — continued. 

flexor brevis pedis, 216, 217. 
carpi radialis, 112. 

ulnaris, 113. 
digitorum brevis pedis, 
191. 
longus pedis, 209. 
longus pollicis manus, 
117. 
pedis, 209. 
ossis metacarpi pollicis, 

126. 
parvus minimi digiti, 

129. 
pollicis longus manus, 

117. 
profundus digitorum, 

116. 
sublimis digitorum, 114. 
gastrocnemius, 206. 
gemellus, 197. 
genio-hyoglossus, 63. 

hyoideus, 63. 

gluteus maximus, 195. 

medius, 195. 

minimus, 196. 

gracilis, 180. 

helicis major, 13. 

minor, 13. 
hyo-glossus, 64. 
iliacus, 166. 
indicator, 124. 
infra-spinatus, 104. 
intercostales, 275-6. 
interossei manus, 129. 

pedis, 219. 
inter-spinales, 274. 
inter-transversales, 275. 
latissimus dorsi, 262. 
levator anguli oris, 16. 
ani, 224, 238. 
costarum, 276. 
labii superius, 15. 

inferius, 20. 
palati, 81. 
palpebrae, 88. 
scapulae, 264. 
lineae longitudinales Lan- 
cisii, 37. 
transversa, 37. 
lingualis, 65, 82. 
linguae superficialis, 82. 
transversalis, 82. 



Muscles — continued. 

linguae verticalis, 82. 
longissimus dorsi, 268. 
longus colli, 76. 
lumbricales, 125, 217. 
masseter, 21. 
multifidus spinae, 274. 
mylo-hyoideus, 62. 
obliquus externus abdomi- 
nis, 141. 

capitis superior, 273. 
inferior, 274. 

oculi, 89. 

inferior oculi, 90. 

internus abdominis, 144. 
obturator externus, 199. 

internus, 197. 
occipito-frontalis, 11. 
omo-hyoideus, 59. 
orbicularis oris, 19. 

ostium venosum, 258. 

palpebrarum, 14. 
palato-glossus, 80. 

pharyngeus, 80. 
palmaris brevis, 125. 

longus, 112. 
pectinalis, 181. 
pectoralis major, 94. 

minor, 95. 
peroneus brevis, 191. 

longus, 189. 

tertius, 189. 
plantaris, 208. 
platysma myoides, 55. 
popliteus, 208. 
pronator quadratus, 117. 

radii teres, 111. 
psoas magnus, 165. 

parvus, 165. 
pterygoideus externus, 22. 

internus, 23. 
pyramidalis, 150. 

nasi, 11. 
pyriformis, 196. 
quadratus femoris, 198. 

lumborum, 167. 
rectus abdominis, 149. 

capitis anticus major, 
77, 272. 
minor, 78, 273. 
lateralis, 78. 
posticus minor,273. 
major, 272. 



304 



INDEX. 



Muscles — continued. 

rectus femoris, 178. 

oculi externus, 89. 
inferior, 88. 
interims, 88. 
superior, 88. 

retrahens aurem, 12. 

rhomboideus major,264. 
minor, 264. 

sacro-lumbalis, 268. 

sartorius, 178. 

scalenus anticus, 76. 
scalenus medius, 76. 

posticus, 76. 
semi-membranosus, 201. 
semi-spinales, 272. 
semi-tendUosus, 200. 
serratus magnus, 265. 

posticus inferior, 267. 
superior, 266. 
soleus, 206. 

sphincter ani internus, 224. 
externus, 224, 240. 

vaginae, 240. 
spinalis dorsi, 268, 270. 
splenius, 266. 
sterno-hyoideus, 59. 

cleido-mastoideus, 57. 

thyroideus, 59. 
stylo-glossus, 62. 
hyoideus alter, 62. 

hyoideus, 60. 

pnaryngeus, 62. 
subclavius, 96. 
subscapularis, 106 
supinator brevis, 122. 

longus, 119. 
supra-spinatus, 104. 
temporal, 21. 
tensor-palati, 80. 

tendo oculi, 14. 

tarsi of Horner, 91. 

vaginae femoris, 177. 
teres major, 106. 

minor, 105. 
thyro-arytenoideus, 85. 

epiglottideus, 86. 

hyoideus, 59. 
tibialis anticus, 188. 

posticus, 210. 
trachelo-mastoideus, 271. 
tragicus, 13. 
transversalis colli, 270. 



Muscles — continued. 

transversalis abdominis, 147. 
transversalis pedis, 217. 
transversus auris, 13. 

perinei, 223, 239. 
alter, 224. 
trapezius, 262. 
triangularis sterni, 276. 
triceps adductor femoris, 
181. 

extensor cubiti, 109. 
vastus externus, 180. 

internus, 180. 
zygomaticus major, 16. 

minor, 16. 
musculi pectinati, 258. 
nares, 79. 
nates cerebri, 42. 

Nerves — 

abducentes, 50. 
accesories, spinal, 58, 72, 75. 
auricularis magnus, 56. 
auditory, 51. 
cardiac, 252. 
cervical, 25, 28. 
cervico-spinal, 72. 
chorda tympani, 28, 32. 
ciliary, 27. 
circumflex, 99. 
comunicans noni, 71. 
cranial. 49. 
crural, '29, 186, 232. 
cutaneous externus of arm, 
99, 137, 139. 

internus, 99, 102, 111, 
114, 142. 

lesser, 99. 

of the thigh, 184. 
dental anterior, 19. 

inferior, 28. 

posterior, 27. 
descendens noni, 71. 
digital, 137, 138. 
dorsal, 29. 
facial, 25, 34. 
fifth pair, 50. 
fourth pair, 50. 
frontal, 28, 92. 
glossopharyngeal, 51, 67. 
gluteal, 201. 
gustatory, 28. 
hypoglossal, 51, 71, 73. 



INDEX. 



305 



Nerves — continued. 

inferior maxillary, 23, 50. 
infra-trochlear, 27. 

orbital, 16, 27, 93. 
intercostal, 258. 
intercosto-humeral, 99. 
ischiaticus major, 29, 202, 
203. 

minor, 203. 
lachrymal, 27, 93. 
laryngeal inferior, 257. 

recurrent, 257. 

superior, 68. 
lingual, 71, 73. 
lumbar, 29. 
maxillary inferior, 12, 28. 

superior, 27. 
median, 99, 137. 
motor oculi, 50, 92. 
musculo-spiral, 99, 138. 
nasal, 27, 92. 
ninth pair, 71. 
obturator, 29, 187, 232. 
occipitalis major, 12. 

minor, 12, 56. 
olfactory, 49. 
ophthalmic, 27, 50, 92. 
optic, 49, 92. 
pathetici, 50, 92. 
par vagum, 51, 173, 257. 
perforans Casserii, 137. 
peroneal, 203. 

cutaneous, 205. 
phrenic, 29, 72, 250. 
plantar, 214. 
pneumogastric, 67, 257. 
popliteal, 202, 203. 
portio dura, 20, 25, 51, 55. 

mollis, 51. 
pudic internal, 202. 
radial, 138. 

recurrent laryngeal, 72, 257. 
respiratory external of Bell, 

103. 
sacral, 29. 
saphenous, long, 187. 

short, 187. 
sciatic, 232. 
sixth pair, 93. 

accessory, 51. 
splanchnic, great, 30, 173. 

less, 167, 252. 
spermatic, 233. 



Nerves — continued. 

superficialis colli, 56. 

superior maxillary, 50, 93. 

supra-orbital, 11, 68. 

supra-scapular, 99, 108. 

sympathetic, 69, 252. 

thoracic humeral, 99. 

thoracic longa, 99. 

tibial anterior, 194,205, 208. 
post, 203, 214. 

trifacial, 27. 

trigeminus, 50. 

ulnar, 99, 138. 
Nipple, 94. 
Nose, 31. 
. alae, 31. 

cartilages of, 31. 

lobulus of, 31. 
Nymphse, 237. 

(Esophagus, 257. 
Omenta, 151, 153. 
Os tincse, 238. 
Ovaries, 242. 

Palatine arches, 78. 
Palpebrae, 90. 
Pancreas, 160. 
Papillae of tongue, 81. 

filiforms, 81. 

maximae, 81. 

mediae, 81. 

minimse, 81. 
Parotid duct, 20. 

gland, 61. 
Penis, 227. 

Pericardium, 245, 248. 
Perineum, 220. 
Peritoneum, 151. 
Pes anserinus, 20. 

hippocampi, 44. 
Peyer's glands, 161. 
Pharynx, 79. 
Pia mater, 36. 
Pineal gland, 42. 
Pituitary, 49. 
Pleura, 244. 
Plexus, axillary, 29, 99. 

brachial, 72, 75, 99. 

cardiac, 251, 257. 

choroid, 40. 

gastric, 173. 

hepatic, 173. 



306 



INDEX. 



Plexus, hypogastric, 254. 

lumbar, 277. 

mesenteric, 173. 

oesophageal, 257. 

phrenic, 250. 

pulmonary, 257. 

rectiformis, 240. 

renal, 173. 

solar, 173. 

spermatic, 173. 

splenic, 173. 

stomachic, 173. 
Prepuce, 227. 

Processus vermiformis superior, 
45. 

inferior, 45. 
Pons Tarini, 47. 

Varolii, 45. 
Processus cerebello ad testes, 42. 
Prostate gland, 228. 
Prostatic sinus, 235. 
Puncta lachrymalia, 90. 
Pupil, 279. 
Pyloric valve, 161. 
Pylorus, 155. 

Raphe of corpus callosum, 37. 

perineum, 221. 
Rectum, 159, 244. 
Retina, 280. 
Rima glottidis, 87. 
Ring, abdominal, exterior, 142. 
interior, 148. 

crural, 166. 

Sacculus larynges, 87. 
Saphenous opening, 174. 
Sclerotic coat, 277. 
Scrotum, 233. 
Semilunar, 260. 
Septum auricularum, 258. 

cordis, 245. 

crurale, 166. 

lucidum, 38. 

pectiniforme, 227, 238. 

ventriculorum, 260. 
Sigmoid flexure, 159. 

valves, 260. 
Sinus, aortic, 261. 

cavernous, 49. 

lateral, 51. 

longitudinal superior, 32. 
inferior, 35. 



Sinus of Valsalva, 260. 

pocularis, 236. 

prostatic, 235. 

rectus, 35, 45. 
Small intestines, 157. 
Spinal cord, 52. 
Spermatic cord, 233. 
Spleen, 160. 
Sphenoidal folds, 38. 
Stomach, 151, 155. 
Substantia perforata, 47. 
Supra-renal capsules, 162. 
Suspensory ligament of liver, 154. 
Synovia, 28. 

Synovial membrane, 281. 
Stylo-maxillary ligament, 281. 

Taenia hippocampi, 44. 

semicircularis, 41. 
Tendinous centre of diaphragm, 

163. 
Tendo Achillis, 207. 

oculi, 90. 

patella, 292. 
Tentorium cerebelli, 34, 44, 48. 
Testes cerebri, 42. 
Testicles, 233. 
Thalami optici, 41. 
Thoracic duct, 173. 
Thorax, 244. 
Thymus gland, 250. 
Tongue, 81. 
Tonsils, 78. 

Torcular Herophili, 44. 
Trachea, 58, 251. 
Tragus, 13. 

Triangular ligament, 225, 228. 
Tricuspid valves, 260. 
Trigonum vesicle, 235. 
Tuber cinereum, 47. 

annulare, 45. 
Tubercula quadrigemina, 42. 
Tuberculum Lowerii, 258. 
Tubuli lactiferi, 94. 
Tunica albuginea of testicle, 233. 

arachnoideus, 35. 

umbilicus, 42. 

vaginalis, 233. 

Urachus, 228. 
Ureter, 162, 243. 
Urethra, 226, 235, 243. 
Urinary bladder, 228. 



INDEX. 



307 



Uterus, 240. 
Uvula, 46, 78. 

Vagina, 238, 240. 
Vallecula, 46. 
Valsalva sinuses, 260. 
Valves, Eustachian, 258. 

ileo-cascal, 161. 

mitral, 260. 

pyloric, 155. 

semilunar, 260. 

tricuspid, 260. 

Vieussens, 42, 46. 
Valvulse conniventes, 161. 
Vas deferens, 226, 233. 
Veins, abdominal, 172. 

axillary, 97. 

azygos major, 255. 
minor, 255. 

basilic, 100. 

cava inferior, 172, 247, 249. 

cava superior, 247. 

cephalic, 94, 100. 

coronary, 258. 

emulgent, 172. 

femoral, 186. 

Galeni, 41. 

gastric, 172. 

hemorrhoidal, 232. 

hepatic, 172. 

iliac, 172. 

innominata, 249. 

intercostal, superior, 255. 

interna or saphenous major, 
174, 187, 190, 205. 
externa, 187. 

jugular, exterior, 56. 
interior, 67. 

lumbar, 172, 258. 

obturator, 186. 



Veins, median, 102. 
basilic, 102. 
cephalic, 102. 

mesenteric, 102, 172. 

orbital, 92. 

pia mater, 36. 

popliteal, 205. 

portal, 172, 175. 

pulmonary, 247. 

spermatic, 172, 233. 

splenic, 175. 

subclavian, 75. 

tibial, 194, 213. 

transversa, 249. 

vallecula, 46. 
Velum inter positum, 41. 

pendulum palati, 78. 
Ventricles of the brain, 38. 

fifth, 38. 

fourth, 45. 

lateral, 38. 

third, 42. 
Ventricles of the heart, 247, 259, 
260. 

larynx, 87. 
Vermiform process, inferior, 46. 
Vesiculse seminales, 226. 
Vestibule, 238. 
Vibrissae, 31. 
Villi, 161. 

Vitreous humor, 280. 
Vocal cords, 87. 
Vulva, 41. 

Wharton duct, 60. 
Willis circle, 52. 
Wilson muscles, 225. 
Wrisberg nerve, 99. 

Zonula ciliaris, 280. 



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